Active NPI
Grant Amoateng
- Mental Health Counselor
- Fairfax, VA
National Provider Identifier
1467273771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 0704017478
- Practice address
- 10301 Democracy LN Ste 302
Fairfax, VA 22030-2545 - Phone
- (571) 223-7588
- NPI assigned
- Oct 19, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 0704017478 | VA | Primary |
Addresses
Primary practice location
10301 Democracy LN Ste 302
Fairfax, VA 22030-2545
Mailing address
10855 Clara Barton Dr
Bristow, VA 20136-1349
Phone (571) 420-6373
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0704017478 | VA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jirah Corporation | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1729296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729296000000",
"number": "1467273771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10855 CLARA BARTON DR",
"city": "BRISTOW",
"state": "VA",
"postal_code": "201361349",
"telephone_number": "571-420-6373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10301 DEMOCRACY LN STE 302",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220302545",
"telephone_number": "571-223-7588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AMOATENG",
"first_name": "GRANT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-10-19",
"last_updated": "2024-10-19",
"certification_date": "2024-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "VA",
"license": "0704017478",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.