Provider Demographics
NPI:1427173798
Name:FONTAINE, DANIEL ARTHUR (LCPC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ARTHUR
Last Name:FONTAINE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 N ELAINE PL
Mailing Address - Street 2:#3W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2453
Mailing Address - Country:US
Mailing Address - Phone:773-392-7983
Mailing Address - Fax:
Practice Address - Street 1:211 E ONTARIO ST
Practice Address - Street 2:SUITE 1195
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3468
Practice Address - Country:US
Practice Address - Phone:312-640-7742
Practice Address - Fax:312-988-9363
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional