Individual
PETER J. FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, LADC
Contact information
Practice address
474 MAIN ST, SPRINGVALE, ME 04083-1409
(207) 324-1500
(207) 490-5263
Mailing address
78 ATLANTIC PLACE, SOUTH PORTLAND, ME 04106-2316
(207) 661-6654
(207) 842-7773
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LC4294
ME
1041C0700X
Clinical Social Worker
Primary
LC4929
ME
Other
Enumeration date
08/30/2011
Last updated
06/22/2016
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