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Individual
TERESA ANTOINETTE FULLER
Active
Individual
TERESA ANTOINETTE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LCDC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
14286
TX
1041C0700X
Clinical Social Worker
Primary
61810
TX
Other
Enumeration date
12/07/2020
Last updated
08/13/2021
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