Individual
MS. JOANN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
470 FOREST AVE, SUITE 202, PORTLAND, ME 04101
(207) 774-3570
(207) 774-3540
Mailing address
179 PEPPERRELL RD, KITTERY POINT, ME 03905-5114
(207) 439-9160
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
XL3862
ME
Other
Enumeration date
12/30/2011
Last updated
12/30/2011
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