| NPI | 1922889112 |
|---|---|
| Other Name | KEDEISHA FOUNTAIN |
| Entity Type | Organization |
| Authorized Contact | KEDEISHA SAMANTHA FOUNTAIN Psychotherapist 475-243-8875 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Enumeration Date | 2023-10-12 |
| Last Update Date | 2023-10-12 |