Individual
LYNN ANN BENTZ FONTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 767-2455
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 767-2455
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LC10558
ME
1041C0700X
Clinical Social Worker
Primary
LC10558
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104760100
—
ME
Enumeration date
08/05/2006
Last updated
03/15/2017
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