Individual
K'CHELLE MARI FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SUD
Contact information
Practice address
1249 SCOTT ST, SAN FRANCISCO, CA 94115-4008
(415) 922-9104
Mailing address
170 9TH ST, SAN FRANCISCO, CA 94103-2603
(415) 255-6544
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
13722
CA
172V00000X
Community Health Worker
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
10/24/2022
Last updated
12/04/2025
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