Individual
MS. JOAN LEE FONTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3500 BALTIMORE AVE, PUEBLO, CO 81008-1543
(719) 545-1181
Mailing address
8166 MAPLE DR, RYE, CO 81069-8811
(719) 489-3438
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
4236
CO
101YM0800X
Mental Health Counselor
Primary
1418
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1418
LPC
CO
01
—
4236
CAC III
CO
Enumeration date
12/27/2006
Last updated
12/03/2010
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