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Individual
MS. SHANNON NOELLE FULCROD
Active
Individual
MS. SHANNON NOELLE FULCROD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, CSAC, MAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710102773
VA
1041C0700X
Clinical Social Worker
Primary
0904007103
VA
Other
Enumeration date
09/06/2013
Last updated
11/07/2024
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