Individual
MS. TARA FULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
707 CORINNE ST, HATTIESBURG, MS 39401-3854
(601) 408-6284
Mailing address
707 CORINNE ST, HATTIESBURG, MS 39401-3854
(601) 408-6284
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C7433
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MMLGN5758X
—
MS
Enumeration date
04/22/2015
Last updated
07/27/2015
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