NPIMap

Organization Active NPI

Inova Kellar Center

  • Adolescent and Children Mental Health Clinic/Center
  • Fairfax, VA
National Provider Identifier
1497808679
Registry record updated Apr 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
033 Issued in VA
Legal business name
INOVA KELLAR CENTER
Practice address
11204 Waples Mill Rd
Fairfax, VA 22030-6048
Phone
(703) 218-8500
Fax
(703) 359-0463
NPI assigned
Jan 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Rick Leichtweis, PH.D
Title
Senior Director
Phone
(703) 218-8500

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Adolescent and Children Mental Health Clinic/Center 261QM0855X 033 VA Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

11204 Waples Mill Rd
Fairfax, VA 22030-6048

Mailing address

PO Box 37511
Baltimore, MD 21297-3511
Phone (703) 218-8500

Other practice location 1

46050 Manekin Plz Ste 110
Sterling, VA 20166-6519
Phone (571) 665-6710

Other practice location 2

11200 Waples Mill Rd Ste 180
Fairfax, VA 22030-7407
Phone (703) 218-8500

Other identifiers 1

IdentifierTypeStateIssuer
4943902MedicaidVA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2177287Inova Kellar Center11204 Waples Mill Road, Fairfax, VA 22030Certificate of waiverJan 7, 2028
49D2177288Inova Kellar Center46050 Manekin Plaza Suite 110, Sterling, VA 20166Certificate of waiverJan 7, 2028

National Provider Directory

National Provider Directory
Tax ID family
Kidney Pancreas Transpl37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

Organizations that report the same tax identification number in the National Provider Directory.

View all 36

Locations

11200 Waples Mill Rd
Ste 180
Fairfax, VA 22030
Phone (703) 218-8500

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777507200000",
    "number": "1497808679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37511",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212973511",
            "telephone_number": "703-218-8500",
            "fax_number": "703-359-0463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11204 WAPLES MILL RD",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220306048",
            "telephone_number": "703-218-8500",
            "fax_number": "703-359-0463"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "46050 Manekin Plz Ste 110",
            "address_purpose": "LOCATION",
            "city": "Sterling",
            "state": "VA",
            "postal_code": "201666519",
            "country_code": "US",
            "telephone_number": "571-665-6710",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11200 Waples Mill Rd Ste 180",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220307407",
            "country_code": "US",
            "telephone_number": "703-218-8500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INOVA KELLAR CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2026-04-30",
        "certification_date": "2026-04-30",
        "status": "A",
        "authorized_official_last_name": "LEICHTWEIS",
        "authorized_official_first_name": "RICK",
        "authorized_official_title_or_position": "SENIOR DIRECTOR",
        "authorized_official_telephone_number": "703-218-8500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "VA",
            "license": "033",
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4943902",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.