Provider Demographics
NPI:1386273456
Name:KOONCE, DUSTIN LYNN (MS)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:LYNN
Last Name:KOONCE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 TIMBERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-2423
Mailing Address - Country:US
Mailing Address - Phone:301-437-1600
Mailing Address - Fax:
Practice Address - Street 1:204 TIMBERWOOD AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-2423
Practice Address - Country:US
Practice Address - Phone:301-437-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor