Individual
LARKIN ELLISON FULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4038 DESOTO STREET, MANDEVILLE, LA 70471
(985) 264-1683
(985) 892-2287
Mailing address
204 EAST 6TH AVENUE, COVINGTON, LA 70433
(985) 264-1683
(985) 892-2287
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4030
LA
Other
Enumeration date
05/11/2006
Last updated
03/08/2016
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