Individual
LARRY FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3807 SW 34TH ST, GAINESVILLE, FL 32608-2511
(352) 378-4583
Mailing address
3807 SW 34TH ST, GAINESVILLE, FL 32608-2511
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
04/08/2009
Last updated
04/08/2009
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