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Individual

MR. CHARLES E FULLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPC

Contact information

Practice address
189 PROFESSIONAL CT SE, SUITE 105, CALHOUN, GA 30701-7053
(706) 979-4037
Mailing address
189 PROFESSIONAL CT SE, SUITE 105, CALHOUN, GA 30701-7053
(706) 979-4037

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC007145
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
LPC007145
STATE OF GEORGIA
GA
Enumeration date
02/08/2010
Last updated
05/01/2013
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