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General NPI Number Information
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NPI Number | 1033407218
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Entity Type | Individual
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Provider Name | CAROLYN DIANA FULCHER LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 215 HAWKS RD STE 12A
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City | MARTIN
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State | TN
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Zip | 38237-2708
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Country | US
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Telephone | 731-281-8070
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Fax | 731-284-0533
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Provider Business Mailing Address
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Address Line | 212 HAWKS ROAD SUITE 12A
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City | MARTIN
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State | TN
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Zip | 38237-2165
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Country | US
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Telephone | 731-281-8070
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Fax | 731-284-0533
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6193
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License Number State | TN
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