Tina M. Fountain, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904005723 Issued in VA

Practice address

612 Hull St Ste 101a
Richmond, VA 23224-4180

Phone

(804) 351-5971

Fax

(804) 351-5972

NPI assigned

Sep 30, 2005

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tinafountain@tdh.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elite Psychotherapy and Behavioral Health Services, LLC

  • Clinical Social Worker
  • Richmond, VA
  • NPI 1780133280
  Medicare reassignment NPD Authorized official
• Insight Physicians PC

  • Psychiatry Physician
  • Richmond, VA
  • NPI 1801817150

  Clinical

  Medicare reassignment NPD
• Supportive Care of Virginia LLC

  • Clinical Psychologist
  • Colonial Heights, VA
  • NPI 1801485354
  Medicare reassignment NPD
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Clinical

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772150400000",
    "number": "1417944992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3209 OAKINGTON DR",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232317267",
            "telephone_number": "804-677-0379",
            "fax_number": "804-351-5972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 HULL ST STE 101A",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232244180",
            "telephone_number": "804-351-5971",
            "fax_number": "804-351-5972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOUNTAIN",
        "first_name": "TINA",
        "middle_name": "M.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-30",
        "last_updated": "2026-02-27",
        "certification_date": "2026-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904005723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fountain Psychological Services, PLLC
• Tami Fountain-Ellis, M.D.
• Caitlin Fountain, PSYD
• Cyre Jacinta Fountain
• Kathryn Michele Fountain, PHARMD
• Kevin Jacob Foust
• Alpha A Fowler III, M.D.
• Sarah R. Fowler
• Stephanie Fowler, PT
• Vanessa Peyton Fowlkes, FNP

• Clinical Social Worker in Richmond, VA
• Providers in Richmond, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.