Provider Demographics
NPI:1295827640
Name:FULLAS, SHERI L (BS MHT)
Entity Type:Individual
Prefix:MS
First Name:SHERI
Middle Name:L
Last Name:FULLAS
Suffix:
Gender:F
Credentials:BS MHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 MUMMA RD
Mailing Address - Street 2:
Mailing Address - City:WORMLEYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1147
Mailing Address - Country:US
Mailing Address - Phone:717-975-5525
Mailing Address - Fax:717-975-8815
Practice Address - Street 1:1035 MUMMA RD
Practice Address - Street 2:
Practice Address - City:WORMLEYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17043-1147
Practice Address - Country:US
Practice Address - Phone:717-975-5525
Practice Address - Fax:717-975-8815
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor