Provider Demographics
NPI:1700305687
Name:KIT FULLER, LMSW, LLC
Entity Type:Organization
Organization Name:KIT FULLER, LMSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:734-255-3342
Mailing Address - Street 1:2890 CARPENTER RD STE 1500
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1196
Mailing Address - Country:US
Mailing Address - Phone:734-255-3342
Mailing Address - Fax:844-364-8448
Practice Address - Street 1:2890 CARPENTER RD STE 1500
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1196
Practice Address - Country:US
Practice Address - Phone:734-255-3342
Practice Address - Fax:844-364-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010899691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty