Provider Demographics
NPI:1235770140
Name:FULGHUM, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:FULGHUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 SPINNAKER LOOP
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-5913
Mailing Address - Country:US
Mailing Address - Phone:352-843-7767
Mailing Address - Fax:
Practice Address - Street 1:5850 SPINNAKER LOOP
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-5913
Practice Address - Country:US
Practice Address - Phone:352-843-7767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor