Provider Demographics
NPI:1518358258
Name:FULMER, MOLLY B
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:B
Last Name:FULMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:B
Other - Last Name:FULMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LCSW
Mailing Address - Street 1:3686 US HIGHWAY 331 S
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-8463
Mailing Address - Country:US
Mailing Address - Phone:850-892-8045
Mailing Address - Fax:850-892-8039
Practice Address - Street 1:3686 US HIGHWAY 331 S
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-8463
Practice Address - Country:US
Practice Address - Phone:850-892-8045
Practice Address - Fax:850-892-8039
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW124421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical