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Individual

JAVANESE FULLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MSW, QMHP-A

Contact information

Practice address
5267 GREENWICH RD STE 101E, VIRGINIA BEACH, VA 23462-6028
(757) 748-3751
Mailing address
4776 MANDAN RD, VIRGINIA BEACH, VA 23462-3843
(757) 748-3751

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary

Other

Enumeration date
11/09/2021
Last updated
11/09/2021
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