Healthcare Provider Details

I. General information

NPI: 1457816621
Provider Name (Legal Business Name): AJALAA FONTAINE POWERS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 SHARON DR STE 206
WESTLAKE OH
44145-1542
US

IV. Provider business mailing address

795 SHARON DR STE 206
WESTLAKE OH
44145-1542
US

V. Phone/Fax

Practice location:
  • Phone: 440-470-0187
  • Fax:
Mailing address:
  • Phone: 419-989-1784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2607419
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: