Individual
MRS. LATASHA A THOMAS-FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
79 GUILFORD CT, SPRING LAKE, NC 28390-7058
(910) 497-0002
Mailing address
79 GUILFORD CT, SPRING LAKE, NC 28390-7058
(910) 497-0002
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408062
—
NC
Enumeration date
07/09/2007
Last updated
08/05/2009
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