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General NPI Number Information
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NPI Number | 1720887300
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Entity Type | Organization
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Legal Business Name | FOUNTAIN PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 7427 BROOK RD
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City | RICHMOND
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State | VA
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Zip | 23227-1816
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Country | US
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Telephone | 919-904-8998
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Fax |
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Provider Business Mailing Address
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Address Line | 617 N 25TH ST
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City | RICHMOND
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State | VA
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Zip | 23223-6537
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAITLIN FOUNTAIN
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Credential | PSYD
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Telephone | 919-904-8998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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