Individual
LAURINA D FULLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC, LCMHC
Contact information
Practice address
3333 S CONGRESS AVE, DELRAY BEACH, FL 33445-7308
(844) 309-9543
Mailing address
PO BOX G, RANDOLPH, VT 05060-0167
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000625
VT
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
05/12/2014
Last updated
11/03/2023
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