Individual
ANTHONY BLAIR FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, MHSP
Contact information
Practice address
3457 KINGSTON PIKE, KNOXVILLE, TN 37919-4633
(865) 207-5841
Mailing address
7023 ROCKINGHAM DR, KNOXVILLE, TN 37909-2525
(865) 207-5841
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1700
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1506511
—
TN
Enumeration date
03/02/2007
Last updated
03/08/2019
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