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General NPI Number Information
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NPI Number | 1336940022
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Entity Type | Organization
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Legal Business Name | FULLER COUNSELING AND EDUCATIONAL RESOURCES LLC
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 55 BRANDT PL
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City | HEFLIN
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State | AL
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Zip | 36264-1428
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Country | US
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Telephone | 256-452-7024
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Fax |
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Provider Business Mailing Address
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Address Line | 174 COUNTY ROAD 66
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City | HEFLIN
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State | AL
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Zip | 36264-6287
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Country | US
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Telephone | 256-452-7024
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Fax |
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Authorized Official
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Title or Position | OWNER, ASSOCIATE LICENSED COUNSELOR
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Name | TIFFANY ROSE FULLER
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Credential | ALC
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Telephone | 256-452-7024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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