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Individual

LATARISHA FOUNTAIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSW

Contact information

Practice address
726 GREEN LN, UNION, NJ 07083-7766
(908) 875-5312
Mailing address
726 GREEN LN, UNION, NJ 07083-7766
(908) 875-5312

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
101YM0800X
Mental Health Counselor
101YP2500X
Professional Counselor
103K00000X
Behavior Analyst
104100000X
Social Worker
Primary
1041C0700X
Clinical Social Worker
1041S0200X
School Social Worker
106H00000X
Marriage & Family Therapist

Other

Enumeration date
12/23/2015
Last updated
05/31/2016
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