Provider Demographics
NPI:1942640107
Name:FULTON, SHONDA YVETTE (LPCA , LCASA)
Entity Type:Individual
Prefix:
First Name:SHONDA
Middle Name:YVETTE
Last Name:FULTON
Suffix:
Gender:F
Credentials:LPCA , LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 SARNIA PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0137
Mailing Address - Country:US
Mailing Address - Phone:704-578-0041
Mailing Address - Fax:
Practice Address - Street 1:7410 SARNIA PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0137
Practice Address - Country:US
Practice Address - Phone:704-578-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10185101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional