Individual
SAMAIYAH FULLYLOVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1855 E SOUTHERN AVE STE 111, MESA, AZ 85204-5227
(602) 842-3130
Mailing address
1855 E SOUTHERN AVE, MESA, AZ 85204-5241
(602) 842-3130
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-22423
AZ
Other
Enumeration date
01/08/2024
Last updated
07/08/2024
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