Individual
KATHERINE MARIE ILLGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, CCTP
Contact information
Practice address
6515 GEORGE WASHINGTON MEM HWY, YORKTOWN, VA 23692-2182
(757) 877-9140
Mailing address
600 MEDICAL DR, HAMPTON, VA 23666-1769
(757) 788-0649
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
090411313
VA
Other
Enumeration date
03/26/2020
Last updated
09/15/2022
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