Individual
NINA VANBROCKLIN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC-C
Contact information
Practice address
335 LITTLE FALLS RD, HOLLIS CENTER, ME 04042-3921
(207) 650-8963
Mailing address
335 LITTLE FALLS RD, HOLLIS CENTER, ME 04042-3921
(207) 650-8963
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
XL4326
ME
Other
Enumeration date
10/29/2014
Last updated
10/29/2014
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