Individual
ALESIA NESIE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4129 MAIN ST., SUITE 202, RIVERSIDE, CA 92501
(909) 244-6159
(951) 443-3714
Mailing address
4129 MAIN ST., SUITE 202, RIVERSIDE, CA 92501
(909) 244-6159
(951) 443-3714
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
25712
CA
103TE1100X
Exercise & Sports Psychologist
25712
CA
103TF0000X
Family Psychologist
25712
CA
Other
Enumeration date
12/13/2011
Last updated
12/13/2011
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