Individual
JACQUELINE FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAAC
Contact information
Practice address
110 E SECOND ST, WINSLOW, AZ 86047-3704
(602) 989-3276
Mailing address
110 E SECOND ST, WINSLOW, AZ 86047-3704
(928) 358-9370
(928) 358-9370
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LIAC-155391
AZ
Other
Enumeration date
07/19/2025
Last updated
09/04/2025
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