Healthcare Provider Details

I. General information

NPI: 1154226231
Provider Name (Legal Business Name): FULFILLING COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 S STATE ROAD 7 STE 303
WELLINGTON FL
33449-8147
US

IV. Provider business mailing address

3319 S STATE ROAD 7 STE 303
WELLINGTON FL
33449-8147
US

V. Phone/Fax

Practice location:
  • Phone: 561-408-5598
  • Fax: 561-437-8431
Mailing address:
  • Phone: 561-408-5598
  • Fax: 561-437-8431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. DIANA ROUSSO
Title or Position: OWNER
Credential: LMHC
Phone: 561-408-5598