Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 1586 | AL |
NPI | 1003148487 |
---|---|
Provider Name | Kelly Rawls Fountain |
First Address | Mobile, AL 36606-2479 |
Second Address | Mobile, AL 36606-2479 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2010 |
Last Update Date | 04/02/2013 |