Individual
CONRAD FOUNTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1930 MARLTON PIKE E STE R91, CHERRY HILL, NJ 08003-4207
(856) 816-7114
(856) 751-0505
Mailing address
1930 MARLTON PIKE E STE R91, CHERRY HILL, NJ 08003-4207
(856) 816-7114
(856) 751-0505
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC00746700
NJ
Other
Enumeration date
07/02/2015
Last updated
07/02/2015
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