Individual
LAURA FONTAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, EDS, LISAC, LPC
Contact information
Practice address
2345 S ALMA SCHOOL RD STE 105, MESA, AZ 85210-4013
(480) 206-4753
Mailing address
18445 E PINE VALLEY DR, QUEEN CREEK, AZ 85142-3622
(480) 206-4753
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC-10622
AZ
101YP2500X
Professional Counselor
Primary
LPC-15936
AZ
Other
Enumeration date
12/07/2015
Last updated
06/18/2019
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