Healthcare Provider Details

I. General information

NPI: 1851722540
Provider Name (Legal Business Name): MS. SHEYVON LATONYA FULLWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHEYVON FULLWOOD TURNER

II. Dates (important events)

Enumeration Date: 12/05/2013
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 W FLORIDA AVE STE 203
HEMET CA
92545-4618
US

IV. Provider business mailing address

4476 POTTERS WHEEL DR
FORT MILL SC
29715-2559
US

V. Phone/Fax

Practice location:
  • Phone: 888-364-3649
  • Fax:
Mailing address:
  • Phone: 888-346-3649
  • Fax: 888-885-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7310
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20812
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: