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General NPI Number Information
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NPI Number | 1669861258
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Entity Type | Individual
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Provider Name | KRISTEN L FULCHER LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/20/2015
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 1080 FIRST COLONIAL RD STE 200
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2406
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Country | US
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Telephone | 757-395-6630
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Fax |
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Provider Business Mailing Address
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Address Line | 3755 E VIRGINIA BEACH BLVD
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City | NORFOLK
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State | VA
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Zip | 23502-3238
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Country | US
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Telephone | 757-823-1312
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Fax | 757-823-1331
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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 | 0904008778
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License Number State | VA
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