Individual
MRS. PAGRITA COMPAGARIS FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
8335 OFFICE PARK DR, DOUGLASVILLE, GA 30134-6937
(678) 324-0476
Mailing address
2669 LANTERN TRL, LITHIA SPRINGS, GA 30122-2792
(936) 676-7760
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW006034
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CSW006043
GA COMPOSITE BOARD OF PC, SW,, AND MFT
GA
01
—
MSW005939
GEORGIA COMPOSITE BOARD OF PC, SW, AND MFT
GA
Enumeration date
04/22/2017
Last updated
04/22/2017
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