Provider Demographics
NPI:1093991986
Name:FONTAINE, EVE N (PHD)
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:N
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 SHADY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8119
Mailing Address - Country:US
Mailing Address - Phone:919-321-2927
Mailing Address - Fax:
Practice Address - Street 1:5015 SOUTHPARK DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7736
Practice Address - Country:US
Practice Address - Phone:919-794-5496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3283103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist