Individual
MARTIA JERONDA FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8401 MEDICAL PLAZA DR STE 360, CHARLOTTE, NC 28262-8700
(704) 208-4458
(866) 309-6385
Mailing address
204 SYCAMORE ST, OXFORD, NC 27565-3625
(919) 339-0649
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
A14117
NC
Other
Enumeration date
10/14/2018
Last updated
01/03/2020
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