Healthcare Provider Details

I. General information

NPI: 1013311026
Provider Name (Legal Business Name): ANNE KILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6154 NEWPORT TER
FREDERICK MD
21701-7602
US

IV. Provider business mailing address

6154 NEWPORT TER
FREDERICK MD
21701-7602
US

V. Phone/Fax

Practice location:
  • Phone: 703-967-0895
  • Fax:
Mailing address:
  • Phone: 703-967-0895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC17599
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: