Individual
LARRY DEWITT FULLER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
307 OLD STONE RD, VILLA RICA, GA 30180-1214
(770) 459-8799
Mailing address
6439 BRIARWOOD CT, RIVERDALE, GA 30296-2904
(404) 433-0307
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC007525
GA
Other
Enumeration date
02/03/2014
Last updated
02/03/2014
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