Individual
MRS. ERICA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CADC III
Contact information
Practice address
1333 NW 9TH ST, PRINEVILLE, OR 97754-1482
(541) 447-2631
(541) 447-2616
Mailing address
1333 NW 9TH ST, PRINEVILLE, OR 97754-1482
(541) 447-2631
(541) 447-2616
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
06-11-92
OR
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
11/01/2011
Last updated
11/01/2011
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