Individual
GRANT AMOATENG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10301 DEMOCRACY LN STE 302, FAIRFAX, VA 22030-2545
(571) 223-7588
Mailing address
10855 CLARA BARTON DR, BRISTOW, VA 20136-1349
(571) 420-6373
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0704017478
VA
Other
Enumeration date
10/19/2024
Last updated
10/19/2024
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