Provider Demographics
NPI:1346663119
Name:FULLER, ALESIA (CBHT)
Entity Type:Individual
Prefix:
First Name:ALESIA
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:CBHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E LAS OLAS BLVD STE 130-514
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2210
Mailing Address - Country:US
Mailing Address - Phone:954-316-1200
Mailing Address - Fax:954-378-1463
Practice Address - Street 1:6848 STIRLING RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-362-0104
Practice Address - Fax:954-364-4595
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor