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General NPI Number Information
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NPI Number | 1366021180
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Entity Type | Individual
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Provider Name | JENNIFER FULLER
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Gender | Female
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 5231 WILLOW RIDGE LN
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City | PINSON
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State | AL
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Zip | 35126-3533
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Country | US
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Telephone | 334-322-3772
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Fax |
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Provider Business Mailing Address
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Address Line | 5231 WILLOW RIDGE LN
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City | PINSON
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State | AL
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Zip | 35126-3533
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Country | US
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Telephone | 334-322-3772
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | C3716A
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC04879
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License Number State | AL
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