Individual
MR. ANDY LEROY FULTON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RAS
Contact information
Practice address
1901 CLEVELAND AVENUE, #B, SANTA ROSA, CA 95401
(707) 576-0818
(707) 576-7845
Mailing address
1901 CLEVELAND AVENUE #B, SANTA ROSA TREATMENT PROGRAM, SANTA ROSA, CA 95401
(707) 576-0818
(707) 576-7845
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
F1101261615
CA
Other
Enumeration date
08/06/2013
Last updated
08/06/2013
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