Individual
CHAROLETTE ANN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RSW
Contact information
Practice address
2219 CLAIBORNE AVE, SHREVEPORT, LA 71103-4301
(318) 779-0434
Mailing address
3772 YOUREE DRIVE, SHREVEPORT, LA 71105
(318) 670-7579
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/28/2016
Last updated
10/16/2018
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