Individual
DONTA' C FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4330 JOHN PENN CIR APT EE, CHARLOTTE, NC 28215-1768
(336) 965-0478
Mailing address
4330 JOHN PENN CIR APT EE, CHARLOTTE, NC 28215-1768
(336) 965-0478
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/19/2019
Last updated
07/19/2019
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