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General NPI Number Information
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NPI Number | 1548527096
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Entity Type | Individual
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Provider Name | JEFFREY ALAN FULMER LCSW
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Gender | Male
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 01/08/2016
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Provider Practice Location Address
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Address Line | 620 COURT ST
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City | LYNCHBURG
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State | VA
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Zip | 24504-1312
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Country | US
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Telephone | 434-847-8035
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Fax | 434-485-8877
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Provider Business Mailing Address
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Address Line | 482 BEDFORD SPRINGS RD
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City | LYNCHBURG
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State | VA
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Zip | 24502-5610
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Country | US
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Telephone | 937-371-1120
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904008669
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License Number State | VA
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