Individual
MRS. MELISSA J FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
128 E MILL ST STE A, KINGSTREE, SC 29556-3428
(843) 401-9217
(843) 354-6461
Mailing address
128 E MILL ST STE A, KINGSTREE, SC 29556-3428
(843) 401-9217
(843) 354-6461
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
6219
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PC1606
—
SC
Enumeration date
11/15/2012
Last updated
05/18/2016
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