Provider Demographics
NPI:1851827786
Name:FULCHER, MACKENZIE (LSW, MSW)
Entity Type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:
Last Name:FULCHER
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 DAISY DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-1201
Mailing Address - Country:US
Mailing Address - Phone:513-532-2759
Mailing Address - Fax:
Practice Address - Street 1:2570 DAISY DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-1201
Practice Address - Country:US
Practice Address - Phone:513-532-2759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS. 1600528104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker