Provider Demographics
NPI:1922319789
Name:FULLEN, MEGAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:FULLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 PINEY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6233
Mailing Address - Country:US
Mailing Address - Phone:703-266-2694
Mailing Address - Fax:
Practice Address - Street 1:14377 HEREFORD RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-2107
Practice Address - Country:US
Practice Address - Phone:703-878-6670
Practice Address - Fax:703-878-3370
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040072631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical