Individual
KELLY KOONTZ THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5570 STERRETT PL, COLUMBIA, MD 21044-2641
(410) 730-0552
Mailing address
5570 STERRETT PL, COLUMBIA, MD 21044-2641
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC3532
MD
Other
Enumeration date
04/12/2023
Last updated
04/12/2023
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