Individual
MR. DERRICK CORNELIUS FULLWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4442 BONNETSVILLE RD, CLINTON, NC 28328-1001
(919) 673-6332
Mailing address
4337 LAKE RIDGE DR, RALEIGH, NC 27604-3469
(919) 673-6332
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/06/2009
Last updated
10/06/2009
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