Healthcare Provider Details

I. General information

NPI: 1912816448
Provider Name (Legal Business Name): APRIL LYNN FULLERTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 PIERREPONT AVE
POTSDAM NY
13676-2294
US

IV. Provider business mailing address

315 BEEBE RD
POTSDAM NY
13676-3330
US

V. Phone/Fax

Practice location:
  • Phone: 315-267-2330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006408
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: