Individual
AVIAE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4718 HEARNE AVE, SHREVEPORT, LA 71108-2703
(318) 828-1521
Mailing address
4718 HEARNE AVE, SHREVEPORT, LA 71108-2703
(318) 828-1521
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/07/2022
Last updated
02/15/2023
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