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General NPI Number Information
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NPI Number | 1851515563
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Entity Type | Organization
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Legal Business Name | FULGRES, INC.
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 1945 J N PEASE PL SUITE 204
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City | CHARLOTTE
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State | NC
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Zip | 28262-4511
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Country | US
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Telephone | 704-449-8907
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Fax | 704-414-8461
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Provider Business Mailing Address
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Address Line | PO BOX 32602
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City | CHARLOTTE
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State | NC
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Zip | 28232-2602
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Country | US
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Telephone | 704-449-8907
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Fax | 704-414-8461
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. TONYA F. GREENE
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Credential | LPC
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Telephone | 704-449-8907
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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