Provider Demographics
NPI:1710465901
Name:FULTON, NICOLE OLIVER (LPCC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:OLIVER
Last Name:FULTON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 SANTA YSABEL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-1137
Mailing Address - Country:US
Mailing Address - Phone:724-328-3360
Mailing Address - Fax:
Practice Address - Street 1:735 SANTA YSABEL AVE
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-1137
Practice Address - Country:US
Practice Address - Phone:724-328-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9232101YP2500X
MDLC10672101YP2500X
MDLGP7269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional