Individual
ILEA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, CAADC
Contact information
Practice address
540 DEPOT ST, HANCOCK, MI 49930-2031
(906) 482-7282
Mailing address
25901 E PINE ST, CALUMET, MI 49913-1257
(906) 369-3949
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
C-03721
MI
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
6401019086
MI
Other
Enumeration date
05/02/2017
Last updated
04/09/2024
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