Provider Demographics
NPI:1770458291
Name:FOUNTAIN, CASION MONEE
Entity type:Individual
Prefix:
First Name:CASION
Middle Name:MONEE
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18089 SORRENTO ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1439
Mailing Address - Country:US
Mailing Address - Phone:313-212-9671
Mailing Address - Fax:
Practice Address - Street 1:18089 SORRENTO ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1439
Practice Address - Country:US
Practice Address - Phone:313-212-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst