Doctor Name: | DR. MAXINE FULLER |
NPI Number: | 1932555711 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., LPC, ED.D |
License Number: | 2703 |
Business Practice Address: | 820 Basswood Dr Adamsville, AL - 350052451 |
Business Phone Number: | 2059147174 |
Business Fax Number: | |
Mailing Address: | 820 Basswood Dr, ADAMSVILLE |
State: | AL |
Postal Code: | 350052451 |
Phone Number: | 2059147174 |
Fax Number: | |
NPI Enumeration Date: | 05/10/2016 |
NPI Last Update Date: | 05/10/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2703 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |