Provider Demographics
NPI:1609431428
Name:FULTON, ALFREDA MARIA (LAC)
Entity Type:Individual
Prefix:
First Name:ALFREDA
Middle Name:MARIA
Last Name:FULTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE CREED GROUP OF LA
Mailing Address - Street 2:2235-A POYDRAS ST
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119
Mailing Address - Country:US
Mailing Address - Phone:504-814-8001
Mailing Address - Fax:504-814-8002
Practice Address - Street 1:2235 POYDRAS ST STE A
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7561
Practice Address - Country:US
Practice Address - Phone:504-814-8001
Practice Address - Fax:504-814-8002
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALAC-5077101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)