Individual
LAURA A FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC, ATR
Contact information
Practice address
114 ORCHARD LAKE RD, PONTIAC, MI 48341-2244
(248) 858-7766
Mailing address
114 ORCHARD LAKE RD, PONTIAC, MI 48341-2244
(248) 858-7766
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401013190
MI
Other
Enumeration date
07/27/2012
Last updated
12/29/2014
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