Individual
MRS. NICOLE RENEE FULLERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, CSW
Contact information
Practice address
25 N SPRUCE ST, COLORADO SPRINGS, CO 80905-1436
(719) 227-4207
(719) 227-4001
Mailing address
2252 PINYON JAY DR, COLORADO SPRINGS, CO 80951-4707
(502) 741-6655
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6986
KY
Other
Enumeration date
03/11/2013
Last updated
07/08/2014
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