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NPI Code Detail

MEDICARE: K'CHELLE MARI FULLER SUD

MEDICARE: K'CHELLE MARI FULLER SUD
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
1101Y00000XCounselor
2373H00000XDay Training/Habilitation Specialist
3101YA0400XAddiction (Substance Use Disorder) Counselor13722CA
4172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1770200511
Entity Type Code : Individual
Provider Name (Legal Business Name) : K'CHELLE MARI FULLER SUD
Provider Business Mailing Address
First Line : 170 9TH ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94103-2603
Country : US
Telephone Number : 415-255-6544
Fax Number :
Provider Business Practice Location Address
First Line : 1249 SCOTT ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94115-4008
Country : US
Telephone Number : 415-922-9104
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2022
Last Update Date : 12/04/2025

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Directions to “ K'CHELLE MARI FULLER SUD” Practice Location

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