Healthcare Provider Details

I. General information

NPI: 1487766549
Provider Name (Legal Business Name): CAROLYN W FULMORE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 ATRIUM WAY STE 221
COLUMBIA SC
29223-6383
US

IV. Provider business mailing address

115 ATRIUM WAY STE 221
COLUMBIA SC
29223-6383
US

V. Phone/Fax

Practice location:
  • Phone: 843-501-1099
  • Fax: 803-699-8824
Mailing address:
  • Phone: 803-699-8887
  • Fax: 803-699-8824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7017
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: