Provider Demographics
NPI:1255824314
Name:FULTON-RESIG, KENNETH CHARLES (MS, LPC,LBS, NCC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:CHARLES
Last Name:FULTON-RESIG
Suffix:
Gender:M
Credentials:MS, LPC,LBS, NCC
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:CHARLES
Other - Last Name:RESIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4772 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-1929
Mailing Address - Country:US
Mailing Address - Phone:412-445-6050
Mailing Address - Fax:
Practice Address - Street 1:4772 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052
Practice Address - Country:US
Practice Address - Phone:412-445-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010478101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional