| Inova Kellar Center | |
|
11204 Waples Mill Rd Fairfax VA 22030-6048 | |
| (703) 218-8500 | |
| (703) 359-0463 |
| Full Name | Inova Kellar Center |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 11204 Waples Mill Rd, Fairfax, Virginia |
| Authorized Official Name and Position | Rick Leichtweis (SENIOR DIRECTOR) |
| Authorized Official Contact | 7032188500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Inova Kellar Center Po Box 1110 Fairfax VA 22038-1110 Ph: (703) 218-8500 | Inova Kellar Center 11204 Waples Mill Rd Fairfax VA 22030-6048 Ph: (703) 218-8500 |
| NPI Number | 1497808679 |
|---|---|
| Provider Enumeration Date | 01/19/2007 |
| Last Update Date | 02/07/2024 |
| Certification Date | 02/07/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497808679 | NPI | - | NPPES |
| 4943902 | Medicaid | VA |
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