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General NPI Number Information
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NPI Number | 1164829834
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Entity Type | Individual
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Provider Name | ALBA FOUNTAIN
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Gender | Female
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 2501 OREGON PIKE
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City | LANCASTER
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State | PA
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Zip | 17601-4890
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Country | US
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Telephone | 717-449-0076
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Fax |
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Provider Business Mailing Address
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Address Line | 815 PENNY LN
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City | MOUNT JOY
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State | PA
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Zip | 17552-9229
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Country | US
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Telephone | 631-576-6998
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BH002145
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License Number State | PA
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