Provider Demographics
NPI:1649939364
Name:FULLER, YASMEEN (MA, LRC-LPC)
Entity type:Individual
Prefix:
First Name:YASMEEN
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:MA, LRC-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S WHITING ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3418
Mailing Address - Country:US
Mailing Address - Phone:571-257-8634
Mailing Address - Fax:
Practice Address - Street 1:101 S WHITING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3418
Practice Address - Country:US
Practice Address - Phone:571-257-8634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704013573101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional