Provider Demographics
NPI:1073957833
Name:FULCHER, DEBRA (MS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:FULCHER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-2404
Mailing Address - Country:US
Mailing Address - Phone:731-587-4357
Mailing Address - Fax:731-587-4353
Practice Address - Street 1:102 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-2404
Practice Address - Country:US
Practice Address - Phone:731-587-4357
Practice Address - Fax:731-587-4353
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health