Individual
TAMMIE LEETTA FULLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1900 SILVER LAKE RD NW, NEW BRIGHTON, MN 55112-1786
(651) 746-2392
(651) 379-1738
Mailing address
10960 FERGUS ST NE UNIT C, BLAINE, MN 55449-5082
(612) 275-0045
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
05/19/2020
Last updated
05/19/2020
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