| Doctor Name: | MAUREEN FULKERSON |
| NPI Number: | 1013322999 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MED, LPC |
| License Number: | 0701005684 |
| Business Practice Address: | 5675 Stone Rd Suite 300 Centreville, VA - 201201667 |
| Business Phone Number: | 5712896725 |
| Business Fax Number: | |
| Mailing Address: | 5675 Stone Rd, CENTREVILLE |
| State: | VA |
| Postal Code: | 201201667 |
| Phone Number: | 7038622206 |
| Fax Number: | |
| NPI Enumeration Date: | 06/30/2014 |
| NPI Last Update Date: | 10/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 0701005684 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |