Provider Demographics
NPI:1508882093
Name:LAFOUNTAIN, KIM (LMHC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:LAFOUNTAIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 GOVERNOR ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3246
Mailing Address - Country:US
Mailing Address - Phone:401-490-3563
Mailing Address - Fax:401-365-1100
Practice Address - Street 1:249 ROOSEVELT AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-2134
Practice Address - Country:US
Practice Address - Phone:401-724-8400
Practice Address - Fax:401-365-1100
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILMHC00274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIBLUE CROSSOtherLMHC