Provider Demographics
NPI:1841437423
Name:FULTON, MELANIE DONNA (LCSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:DONNA
Last Name:FULTON
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 1:501 SOUTHWEST DR STE A4
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5858
Mailing Address - Country:US
Mailing Address - Phone:501-819-2317
Mailing Address - Fax:
Practice Address - Street 1:501 SOUTHWEST DR STE A4
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5858
Practice Address - Country:US
Practice Address - Phone:501-819-2317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4007-C1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical