Individual
JARVIS FOUNTAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CIT
Contact information
Practice address
5505 SHREVEPORT HWY, PINEVILLE, LA 71360-3533
(318) 441-5900
Mailing address
506 WELWYN WAY, ALEXANDRIA, LA 71303-2617
(318) 880-1289
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
12/07/2022
Last updated
12/07/2022
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