Provider Demographics
NPI:1831123975
Name:KOONTZ-KEAN, KATHRYN J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:J
Last Name:KOONTZ-KEAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 CANVASBACK LN
Mailing Address - Street 2:
Mailing Address - City:HEATHSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22473-3707
Mailing Address - Country:US
Mailing Address - Phone:804-580-6160
Mailing Address - Fax:
Practice Address - Street 1:555 CANVASBACK LN
Practice Address - Street 2:
Practice Address - City:HEATHSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22473-3707
Practice Address - Country:US
Practice Address - Phone:804-580-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040046241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical