Jacqueline Fountain, LAAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Winslow, AZ
NPI 1982596243 · NPPES record last updated Sep 4, 2025
Key facts
- NPI
- 1982596243
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- LIAC-155391 (AZ)
- Practice address
- 110 E Second St
Winslow, AZ 86047-3704 - Phone
- (602) 989-3276
- NPI assigned
- Jul 19, 2025
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LIAC-155391 | AZ | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LIAC-155391 | AZ | Yes |
Addresses
Primary practice location
110 E Second St
Winslow, AZ 86047-3704
Mailing address
110 E Second St
Winslow, AZ 86047-3704
Phone (928) 358-9370
Other providers in Winslow, AZ
- Leandra Elthie
- Emcare Physician Providers, Inc
- Bryan Andrew Feinstein
- David Michael Ferguson
- Alexia Simao Fernandes
- Jessica L Fugatt
- Veronica Fuson
- Melanie Gable
- Janelle Dawn Gaddis
- Rosa Idalia Gallegos
All providers in Winslow, AZ · Addiction (Substance Use Disorder) Counselor in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.