Fountain, Tina M.
Fountain, Tina M. is an sole proprietor health care provider with primary practice located at 2006 Bremo Rd Suite 101, Richmond VA 23226-2438. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Fountain, Tina M. can be contacted via phone (804) 288-1881.Contact Information
Primary practice address
2006 Bremo Rd Suite 101
Richmond VA 23226-2438
Phone: (804) 288-1881
Fax: (804) 282-6413
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 0904005723 | Virginia |
Profile Details
| NPI number | 1417944992 |
|---|---|
| LBN Legal business name | Fountain, Tina M. |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 30th, 2005 |
| Last updated | Oct 26th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417944992 | NPPES |
| Virginia | MEDICAID | 010162025 |
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