MEDICARE: NICHOLLE KILIAN M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0704017549	VA

General Provider Information

NPI Number	:	1821944885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLLE KILIAN M.A.

Provider Business Mailing Address
First Line	:	4835 WATERLICK RD STE A
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-1696
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	542 LEESVILLE RD APT 119
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-2351
Country	:	US
Telephone Number	:	803-477-2527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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