Basic Information
| Provider Information | |||||||||
| NPI: | 1285691626 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KILLIAN | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | SNOW | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11715 FAWN LAKE PKWY | ||||||||
| Address2: | |||||||||
| City: | SPOTSYLVANIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 225518903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403733223 | ||||||||
| FaxNumber: | 5403713753 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224015719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403733223 | ||||||||
| FaxNumber: | 5403713753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 03/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904001474 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 08936 | 01 | VA | SENTARA | OTHER | 4945123 | 05 | VA | MEDICAID | 274266 | 01 | VA | ANTHEM | OTHER | 288888 | 01 | VA | MDIPA | OTHER | 5411830373 | 01 | VA | TRICARE | OTHER |