Individual
DR. TINA MARCELLE FOUNTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1131 AIRPORT RD, MILFORD, DE 19963-6418
(443) 477-2156
Mailing address
85 ABIGAIL LN, MAGNOLIA, DE 19962-3251
(443) 477-2156
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
018018-1
NY
103T00000X
Psychologist
Primary
B1-0000807
DE
Other
Enumeration date
10/15/2012
Last updated
04/19/2013
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