Individual
MARIO FULTON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
510 PAYNE AVE, COVINGTON, TN 38019-3016
(731) 612-2426
Mailing address
510 PAYNE AVE, COVINGTON, TN 38019-3016
(731) 612-2426
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
14661
TN
1041S0200X
School Social Worker
—
—
Other
Enumeration date
02/12/2024
Last updated
02/12/2024
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