Individual
AMANDA FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
825 WINSHAM DR, COLUMBIA, SC 29229-7460
(803) 743-7054
Mailing address
1460 OAKCREST DR APT 1724, COLUMBIA, SC 29223-1744
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/30/2021
Last updated
08/30/2021
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