Healthcare Provider Details

I. General information

NPI: 1144554973
Provider Name (Legal Business Name): REBECCA LYNN FULCHER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2009
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3259 CATLIN AVE
QUANTICO VA
22134-5109
US

IV. Provider business mailing address

1 LEFRAK CITY PLZ ROOM 1525
CORONA NY
11368-4160
US

V. Phone/Fax

Practice location:
  • Phone: 703-784-1779
  • Fax:
Mailing address:
  • Phone: 718-760-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number018071-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005162
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: