Larry Dewitt Fuller JR. M.A.

NPI 1700209327 - Counselor - 101YP2500X

NPI Details
NPI 1700209327
Gender Male
Enumeration Date 02/03/2014
Last Updated 02/03/2014
Entity Type Individual
Active Over 2 years ago
Practice Location
307 OLD STONE RD
VILLA RICA GA, 30180-1214, US
Phone (770) 459-8799
Fax
Business Location
6439 BRIARWOOD CT
RIVERDALE GA, 30296-2904, US
Phone (404) 433-0307
Fax
Toxanomy
Taxonomy Code 101YP2500X
License State Georgia
License Number LPC007525
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According to our database, Larry Dewitt Fuller JR. M.A. NPI is 1700209327, taxonomy code is 101YP2500X and license number is LPC007525, license state is located at Georgia. Larry Dewitt Fuller JR. M.A. physically located at 307 Old Stone Rd, Villa Rica GA, 30180-1214. NPI Number Larry Dewitt Fuller JR. M.A. has the Individual type.

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1700209327 NPI number is provided on an as is basis without warranty of any kind. 1700209327 is maintained by the National Plan & Provider Enumeration System. The contents of Larry Dewitt Fuller JR. M.A. are for informational purposes only.