Individual
DENNA MARIE FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, QMHP, CADCIII
Contact information
Practice address
2073 OLYMPIC ST, SPRINGFIELD, OR 97477
(541) 682-3550
(541) 682-3551
Mailing address
2073 OLYMPIC ST, SPRINGFIELD, OR 97477-3413
(541) 682-3550
(541) 682-3551
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1309-50
OR
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
L8032
OR
Other
Enumeration date
10/05/2009
Last updated
02/03/2020
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