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General NPI Number Information
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NPI Number | 1346532843
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Entity Type | Individual
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Provider Name | MICHAEL D FOUNTAIN MA, NCC, LAPC
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Gender | Male
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 1870 ROBLE DRIVE
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City | ATLANTA
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State | GA
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Zip | 30349-9117
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Country | US
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Telephone | 678-235-4939
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Fax | 770-994-5444
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Provider Business Mailing Address
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Address Line | PO BOX 491117
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City | ATLANTA
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State | GA
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Zip | 30349-9117
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Country | US
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Telephone | 678-235-4939
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Fax | 770-994-5444
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0002892
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License Number State | GA
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