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General NPI Number Information
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NPI Number | 1093947400
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Entity Type | Individual
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Provider Name | CONNOR KEUNTJE LPC, LCPC
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Gender | Male
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 15000 POTOMAC TOWN PL # 184
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City | WOODBRIDGE
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State | VA
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Zip | 22191-6586
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Country | US
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Telephone | 703-493-0650
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Fax |
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Provider Business Mailing Address
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Address Line | 15000 POTOMAC TOWN PL # 184
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City | WOODBRIDGE
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State | VA
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Zip | 22191-6586
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Country | US
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Telephone | 703-493-0650
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701009042
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC14465
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC12515
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License Number State | MD
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