Individual
MR. CORNELIUS FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LBSW
Contact information
Practice address
1 PARKLANE BLVD STE 200E, DEARBORN, MI 48126-2400
(313) 846-2606
Mailing address
3800 WOODWARD AVE, STE 600, DETROIT, MI 48201-2061
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802033061
MI
Other
Enumeration date
05/09/2007
Last updated
02/12/2025
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