| Doctor Name: | GEORGEINA M KOONTZ |
| NPI Number: | 1972731263 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCAS |
| License Number: | 1420 |
| Business Practice Address: | 301 E Main St Ste 5 Cherryville, NC - 280213410 |
| Business Phone Number: | 7044352577 |
| Business Fax Number: | 7044352578 |
| Mailing Address: | Po Box 518, CHERRYVILLE |
| State: | NC |
| Postal Code: | 280210518 |
| Phone Number: | 7044352577 |
| Fax Number: | 7044352578 |
| NPI Enumeration Date: | 06/25/2009 |
| NPI Last Update Date: | 01/19/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1420 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |