Individual
LISA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
A2206021
AR
101YP2500X
Professional Counselor
Primary
P2501006
AR
Other
Enumeration date
08/22/2022
Last updated
05/12/2025
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