Individual
MELISSA PORTIA FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
7895 CURRIER DR, PORTAGE, MI 49002-4314
(269) 910-7327
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
6401014638
MI
101YP2500X
Professional Counselor
Primary
6401014638
MI
Other
Enumeration date
09/11/2019
Last updated
02/29/2024
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