Healthcare Provider Details

I. General information

NPI: 1285318089
Provider Name (Legal Business Name): KILEXYUS BRIERRA MOORE MSSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 EISENHOWER AVE STE 220
ALEXANDRIA VA
22314-4587
US

IV. Provider business mailing address

2800 EISENHOWER AVE STE 220
ALEXANDRIA VA
22314-4587
US

V. Phone/Fax

Practice location:
  • Phone: 540-358-0423
  • Fax:
Mailing address:
  • Phone: 540-358-0423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020373
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: