Provider Demographics
NPI:1710310107
Name:FULLER, RASHARA NICHOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RASHARA
Middle Name:NICHOLE
Last Name:FULLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 NEPTUNE BLVD
Mailing Address - Street 2:692
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-3610
Mailing Address - Country:US
Mailing Address - Phone:908-202-1467
Mailing Address - Fax:
Practice Address - Street 1:50 NEPTUNE BLVD
Practice Address - Street 2:692
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-0775
Practice Address - Country:US
Practice Address - Phone:908-202-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00710500101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor