Individual
EBONY FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
52 TURNBURY DR, BOSSIER CITY, LA 71111-8203
(318) 655-5720
Mailing address
52 TURNBURY DR, BOSSIER CITY, LA 71111-8203
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/29/2015
Last updated
07/29/2019
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