Provider Demographics
NPI:1730295072
Name:KOONTZPERRYMAN, KANDACE (LPC, NCC, MA)
Entity Type:Individual
Prefix:MRS
First Name:KANDACE
Middle Name:
Last Name:KOONTZPERRYMAN
Suffix:
Gender:F
Credentials:LPC, NCC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 HAMILTON PLACE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262
Mailing Address - Country:US
Mailing Address - Phone:336-885-2116
Mailing Address - Fax:
Practice Address - Street 1:1312 HAMILTON PL
Practice Address - Street 2:ST. 105
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262
Practice Address - Country:US
Practice Address - Phone:336-885-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4873101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional