Individual
LISA FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
18 TIERRA MONTE ST NE, ALBUQUERQUE, NM 87122-2102
(505) 249-1669
Mailing address
18 TIERRA MONTE ST NE, ALBUQUERQUE, NM 87122-2102
(505) 249-1669
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SWB-2024-0077
NM
Other
Enumeration date
01/22/2024
Last updated
01/22/2024
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