Doctor Name: | MR. ADRIAN K FULLER |
NPI Number: | 1023368479 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S., ED.S |
License Number: | |
Business Practice Address: | 740 Florida Central Pkwy Ste 1028 Longwood, FL - 327507652 |
Business Phone Number: | 4077742284 |
Business Fax Number: | 4077742285 |
Mailing Address: | 740 Florida Central Pkwy Ste 1028, LONGWOOD |
State: | FL |
Postal Code: | 327507652 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/13/2012 |
NPI Last Update Date: | 09/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |