Individual
BRIAN H FONTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADAC II
Contact information
Practice address
2125 E 450 S, LA PORTE, IN 46350-7649
(192) 608-4926
Mailing address
2125 E 450 S, LA PORTE, IN 46350-7649
(192) 608-4926
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
C2-5180
IN
103TA0400X
Addiction (Substance Use Disorder) Psychologist
C2-5180
IN
106S00000X
Behavior Technician
C2-5180
IN
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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