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NPI Code Detail

MEDICARE: MRS. NICOLE C. FULLER LPCC-S

MEDICARE: MRS. NICOLE C. FULLER LPCC-S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorE0008339SUPVOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700054491
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLE C. FULLER LPCC-S
Provider Business Mailing Address
First Line : 625 CLEVELAND AVE NW
Second Line :
City : CANTON
State : OH
Zip : 44702-1805
Country : US
Telephone Number : 330-455-0371
Fax Number : 330-453-6716
Provider Business Practice Location Address
First Line : 601 CLEVELAND AVE NW
Second Line :
City : CANTON
State : OH
Zip : 44702-1836
Country : US
Telephone Number : 330-455-0374
Fax Number : 330-453-6716
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2008
Last Update Date : 09/26/2019

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Directions to “ MRS. NICOLE C. FULLER LPCC-S” Practice Location

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