Individual
COKIENA N FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1115 W CHESTNUT ST, BROCKTON, MA 02301-7501
(508) 580-4691
Mailing address
1115 W CHESTNUT ST, BROCKTON, MA 02301-7501
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/23/2012
Last updated
01/23/2012
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