Individual
KRISTEN L FULCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1080 FIRST COLONIAL RD STE 200, VIRGINIA BEACH, VA 23454-2406
(757) 395-6630
Mailing address
3755 E VIRGINIA BEACH BLVD, NORFOLK, VA 23502-3238
(757) 823-1312
(757) 823-1331
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904008778
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669861258
—
VA
01
—
Q53979A
MEDICARE
VA
Enumeration date
01/20/2015
Last updated
11/23/2022
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