Healthcare Provider Details

I. General information

NPI: 1023511425
Provider Name (Legal Business Name): MEGAN GOARD FULLER ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 06/24/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 LANKFORD HWY
OAK HALL VA
23416-2114
US

IV. Provider business mailing address

28124 GROTON TOWN ROAD
HALLWOOD VA
23359
US

V. Phone/Fax

Practice location:
  • Phone: 757-824-3360
  • Fax:
Mailing address:
  • Phone: 757-894-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0813000844
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: