Individual
CAROLYN FULGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5471 DR MARTIN LUTHER KING DR, SAINT LOUIS, MO 63112-4265
(314) 367-5820
Mailing address
330 N GORE AVE, SAINT LOUIS, MO 63119-1600
(314) 968-2060
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
2015029538
MO
1041C0700X
Clinical Social Worker
Primary
2020021039
MO
Other
Enumeration date
10/23/2015
Last updated
11/03/2020
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