Provider Demographics
NPI:1023368479
Name:FULLER, ADRIAN K JR (MS, EDS)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:K
Last Name:FULLER
Suffix:JR
Gender:M
Credentials:MS, EDS
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:740 FLORIDA CENTRAL PKWY STE 1028
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-7652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:740 FLORIDA CENTRAL PKWY STE 1028
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-7652
Practice Address - Country:US
Practice Address - Phone:407-774-2284
Practice Address - Fax:407-774-2285
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health