Provider Demographics
NPI:1790200988
Name:FULTON, KATHERINE MARY (CDP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MARY
Last Name:FULTON
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17014 59TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-4875
Mailing Address - Country:US
Mailing Address - Phone:360-435-3985
Mailing Address - Fax:360-435-7941
Practice Address - Street 1:17014 59TH AVE NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-4875
Practice Address - Country:US
Practice Address - Phone:360-435-3985
Practice Address - Fax:360-435-7941
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60271906101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP60271906Medicaid