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General NPI Number Information
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NPI Number | 1093991986
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Entity Type | Individual
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Provider Name | EVE N. FONTAINE PHD
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Gender | Female
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 01/12/2011
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Provider Practice Location Address
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Address Line | 5015 SOUTHPARK DR
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City | DURHAM
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State | NC
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Zip | 27713-7736
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Country | US
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Telephone | 919-794-5496
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Fax |
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Provider Business Mailing Address
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Address Line | 3505 SHADY CREEK DR
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City | DURHAM
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State | NC
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Zip | 27713-8119
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Country | US
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Telephone | 919-321-2927
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3283
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License Number State | NC
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