Provider Demographics
NPI:1164293403
Name:FULLY HUMAN PLLC
Entity Type:Organization
Organization Name:FULLY HUMAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:BENJAMIN SAMUEL
Authorized Official - Last Name:FLEITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:434-328-1044
Mailing Address - Street 1:107 VINCENNES RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8551
Mailing Address - Country:US
Mailing Address - Phone:703-239-4424
Mailing Address - Fax:571-933-4262
Practice Address - Street 1:1550 WILSON BLVD
Practice Address - Street 2:STE 700 #226
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2490
Practice Address - Country:US
Practice Address - Phone:703-239-4424
Practice Address - Fax:571-933-4262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty