Individual
SHANNA FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4630 OPELOUSAS CT, GRAND PRAIRIE, TX 75052-1738
(972) 374-7557
Mailing address
4630 OPELOUSAS CT, GRAND PRAIRIE, TX 75052-1738
(972) 374-7557
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15726
TX
Other
Enumeration date
07/22/2022
Last updated
07/22/2022
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