Provider Demographics
NPI:1295160307
Name:KOONTZ, KATHLEEN D (LPCMH)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:D
Last Name:KOONTZ
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BOYER DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-2891
Mailing Address - Country:US
Mailing Address - Phone:302-442-0342
Mailing Address - Fax:
Practice Address - Street 1:260 CHAPMAN ROAD
Practice Address - Street 2:100 B
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702
Practice Address - Country:US
Practice Address - Phone:302-292-1334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-08
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000646101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health