Healthcare Provider Details

I. General information

NPI: 1700130382
Provider Name (Legal Business Name): SANDY KILADA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E CAPITOL ST SE
WASHINGTON DC
20003-3903
US

IV. Provider business mailing address

902 1/2 PENDLETON ST
ALEXANDRIA VA
22314-1835
US

V. Phone/Fax

Practice location:
  • Phone: 703-627-2997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC14044
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: