Provider Demographics
NPI:1851693212
Name:KOON, AIMEE LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:LYNN
Last Name:KOON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GAMECOCK AVE
Mailing Address - Street 2:SUITE 710
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3379
Mailing Address - Country:US
Mailing Address - Phone:843-532-6785
Mailing Address - Fax:
Practice Address - Street 1:7 GAMECOCK AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3379
Practice Address - Country:US
Practice Address - Phone:843-532-6785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional