Individual
DR. KATINA FELISA FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DSW, LCSW, CCM
Contact information
Practice address
212 BONNIE SUE DR, VILLA RICA, GA 30180-5517
(678) 739-8497
Mailing address
212 BONNIE SUE DR, VILLA RICA, GA 30180-5517
(678) 739-8497
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW007891
GA
Other
Enumeration date
10/10/2023
Last updated
10/10/2023
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