Organization
INOVA KELLAR CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICK LEICHTWEIS PH.D (SENIOR DIRECTOR)
(703) 218-8500
Entity
Organization
Contact information
Practice address
11204 WAPLES MILL RD, FAIRFAX, VA 22030-6048
(703) 218-8500
(703) 359-0463
Mailing address
PO BOX 37511, BALTIMORE, MD 21297-3511
(703) 218-8500
(703) 359-0463
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
033
VA
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4943902
—
VA
Enumeration date
01/19/2007
Last updated
04/30/2026
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