| Doctor Name: | MRS. MELISSA J FULTON |
| NPI Number: | 1437493582 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 6219 |
| Business Practice Address: | 128 E Mill St Ste A Kingstree, SC - 295563428 |
| Business Phone Number: | 8434019217 |
| Business Fax Number: | 8433546461 |
| Mailing Address: | 128 E Mill St Ste A, KINGSTREE |
| State: | SC |
| Postal Code: | 295563428 |
| Phone Number: | 8434019217 |
| Fax Number: | 8433546461 |
| NPI Enumeration Date: | 11/15/2012 |
| NPI Last Update Date: | 05/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6219 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | SC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |