Individual
KATHLEEN FOUNTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4813B EISENHOWER AVE, ALEXANDRIA, VA 22304-4832
(571) 402-2541
Mailing address
3400 S BRAHMA BLVD APT 30A, KINGSVILLE, TX 78363-7341
(703) 201-3191
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904012417
VA
Other
Enumeration date
03/23/2021
Last updated
03/23/2021
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