Individual
CHARLOTTE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
914 MISSION AVE, SAN RAFAEL, CA 94901-6106
(415) 457-6966
(415) 721-0281
Mailing address
235 BOLINAS RD, APT. #6, FAIRFAX, CA 94930-1968
(415) 456-9350
(415) 456-1508
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
CA
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
01/03/2007
Last updated
05/16/2016
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