Provider Demographics
NPI:1871316109
Name:KILGORE, MAURICE RANDOLPH (LCSWS)
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:RANDOLPH
Last Name:KILGORE
Suffix:
Gender:M
Credentials:LCSWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 GENESEE PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-8302
Mailing Address - Country:US
Mailing Address - Phone:571-659-0056
Mailing Address - Fax:571-659-0695
Practice Address - Street 1:4000 GENESEE PL
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8302
Practice Address - Country:US
Practice Address - Phone:571-659-0056
Practice Address - Fax:571-659-0695
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical