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General NPI Number Information
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NPI Number | 1972755692
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Entity Type | Individual
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Provider Name | LESLIE GRACE KILLE ED.D, LCSW, LAC
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Gender | Female
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Dates
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Enumeration Date | 10/13/2008
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 7780 S BROADWAY STE 300
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City | LITTLETON
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State | CO
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Zip | 80122-2633
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Country | US
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Telephone | 727-056-0754
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Fax |
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Provider Business Mailing Address
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Address Line | 7780 S BROADWAY STE 300
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City | LITTLETON
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State | CO
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Zip | 80122-2633
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Country | US
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Telephone | 727-560-7546
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACD.0002251
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW.09926490
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License Number State | CO
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