# ILEA FULLER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1467988170
- **Gender:** F
- **Credential:** LPC, CAADC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | C-03721 | MI | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | 6401019086 | MI | — |

## Other

- **Enumeration date:** 05/02/2017
- **Last updated:** 04/09/2024