Healthcare Provider Details

I. General information

NPI: 1104566447
Provider Name (Legal Business Name): FAITH DIANE FULCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MANOR LN
SWANSBORO NC
28584-8531
US

IV. Provider business mailing address

22 MANOR LN
SWANSBORO NC
28584-8531
US

V. Phone/Fax

Practice location:
  • Phone: 252-734-0493
  • Fax:
Mailing address:
  • Phone: 252-734-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: