Individual
CAMERON FOUNTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC
Contact information
Practice address
612 N STORY RD STE 101, IRVING, TX 75061-6764
(469) 708-2955
Mailing address
8109 SKILLMAN ST APT 3008, DALLAS, TX 75231-2828
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
TX
Other
Enumeration date
07/31/2020
Last updated
07/31/2020
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