Individual
NA-ILAH IMANI FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
160 CLAIREMONT AVE STE 200, DECATUR, GA 30030-2546
(678) 954-5721
Mailing address
1045 MOSSCROFT CT, LAWRENCEVILLE, GA 30045-9788
(770) 608-1916
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-23-66096
GA
Other
Enumeration date
07/02/2019
Last updated
09/06/2024
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