| NPI | 1942325170 |
|---|---|
| Former Name | MELISSA MARIS FOUNTAIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC4125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD844) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2024-01-22 |