Provider Demographics
NPI:1568232080
Name:FULLER, RASHIDA ASHA (LCSW-A)
Entity Type:Individual
Prefix:
First Name:RASHIDA
Middle Name:ASHA
Last Name:FULLER
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LOOP ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-4062
Mailing Address - Country:US
Mailing Address - Phone:910-596-2221
Mailing Address - Fax:910-596-2229
Practice Address - Street 1:100 LOOP ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-4062
Practice Address - Country:US
Practice Address - Phone:910-596-2221
Practice Address - Fax:910-596-2229
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0183371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical