Provider Information for 1417944992
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TINA M. FOUNTAIN LCSW
Sex: Female
NPI: 1417944992
Last Updated: 2016-10-26
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1417944992 | ||||||||
| Enumeration Date | 2005-09-30 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2006 BREMO RD SUITE 101 RICHMOND, VA 23226-2438 United States Phone: 804-288-1881 | Fax:804-282-6413 | ||||||||
| Primary Practice Address | 2006 BREMO RD SUITE 101 RICHMOND, VA 23226-2438 United States Phone: 804-288-1881 | Fax:804-282-6413 | ||||||||
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