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1669091286
EVAN THEODORE FULFORD
DETROIT, MI
NPI
1669091286
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: MI 6801106033)
Enumeration Date
2020-04-14
Last Update Date
2020-04-14
Business Address
EVAN THEODORE FULFORD LMSW
19928 LICHFIELD RD
DETROIT, MI 48221-1363
Phone number: 313-804-8128
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Mailing Address
EVAN THEODORE FULFORD LMSW
19928 LICHFIELD RD
DETROIT, MI 48221-1363
Phone number: 313-804-8128
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