Active NPI
Y Fountain, PHD, LPC, RPT
- Professional Counselor
- Tucker, GA
National Provider Identifier
1649683848
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC006900
- Practice address
- 1479 Brockett Rd
Suite 100
Tucker, GA 30084-7326 - Phone
- (770) 375-8124
- NPI assigned
- Jun 4, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC006900 | GA | Primary |
Addresses
Primary practice location
1479 Brockett Rd
Suite 100
Tucker, GA 30084-7326
Mailing address
3545 Broad St # 80742
Atlanta, GA 30341-2259
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC006900 | GA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Play Wellness LLC | Professional | Past | Accepting new patients |
| Healthy Minds Psychology Associates Inc | Professional | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Professional Counselor
- Atlanta, GA
- NPI 1689072068
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428105600000",
"number": "1649683848",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3545 BROAD ST # 80742",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303412259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1479 BROCKETT RD",
"address_2": "SUITE 100",
"city": "TUCKER",
"state": "GA",
"postal_code": "300847326",
"telephone_number": "770-375-8124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOUNTAIN",
"first_name": "Y",
"credential": "PHD, LPC, RPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-04",
"last_updated": "2015-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC006900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.