Individual
LAVISHIA TIAH FULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2610 HOUSTON AVE, RICHMOND, VA 23222-3824
(804) 564-4493
Mailing address
2610 HOUSTON AVE, RICHMOND, VA 23222-3824
(804) 564-4493
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/26/2021
Last updated
07/26/2021
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