Individual
ANDREYA FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDPT
Contact information
Practice address
2156 PACIFIC AVE, TACOMA, WA 98402-3004
(253) 200-0505
(253) 200-0636
Mailing address
2156 PACIFIC AVE, TACOMA, WA 98402-3004
(253) 200-0505
(253) 200-0636
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
60985197
WA
Other
Enumeration date
11/18/2020
Last updated
11/18/2020
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