Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
FOUNTAIN THERAPEUTIC AND SUPPORTIVE SERVICES LLC
Active
Organization
FOUNTAIN THERAPEUTIC AND SUPPORTIVE SERVICES LLC
Active
Other names
MiraLife Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
JANNY JINOR LICSW (MANAGER)
(301) 437-9666
Entity
Organization
Contact information
Practice address
108 CARDIFF CT # CY, JACKSONVILLE, NC 28546-7864
(301) 437-9666
Mailing address
108 CARDIFF CT, JACKSONVILLE, NC 28546-7864
(301) 437-9666
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC50078852
DC
Other
Enumeration date
03/31/2010
Last updated
02/11/2015
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up