Provider Demographics
NPI:1689890022
Name:KOONTZ, GRANT AARON (LPC)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:AARON
Last Name:KOONTZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5224 DENMEAD WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-5627
Mailing Address - Country:US
Mailing Address - Phone:919-848-7949
Mailing Address - Fax:
Practice Address - Street 1:207 W MILLBROOK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4393
Practice Address - Country:US
Practice Address - Phone:919-649-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7363101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional