Individual
KEDEISHA FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
821 SUCCESS AVE, STRATFORD, CT 06614-3731
(475) 243-8875
Mailing address
18 CADBURY PLACE, NAUGATUCK, CT 06770
(475) 243-8875
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
04/11/2008
Last updated
10/12/2023
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