| NPI | 1801380639 |
|---|---|
| Former Name | JESSICA L FULLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA171018) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2020-04-20 |