MEDICARE: FARRAH FULLER

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
1	1041C0700X	Clinical Social Worker	P023253	NC

General Provider Information

NPI Number	:	1942155346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARRAH FULLER

Provider Business Mailing Address
First Line	:	3500 WESTGATE DR # 304
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-2567
Country	:	US
Telephone Number	:	919-451-6337
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 WESTGATE DR # 304
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-2567
Country	:	US
Telephone Number	:	919-451-6337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ FARRAH FULLER ” Practice Location

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