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XAVIER QUAMAINE LEE FULLERTON LPC-A, CRC
NPI 1215490966
Counselor - Mental Health in Winston Salem, NC

Active since April 10, 2019
140 KIMEL PARK DR STE 101, WINSTON SALEM, NC 27103(336) 718-7280(336) 718-7290 Get Directions Write a Review

NPPES record last updated: August 23, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 23, 2023, May 9, 2022, Apr 10, 2019 (3 updates tracked since 2019).

About Xavier Quamaine Lee Fullerton Lpc-a, Crc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

XAVIER QUAMAINE LEE FULLERTON LPC-A, CRC (NPI 1215490966) is an individual mental health provider in Winston Salem, North Carolina, licensed in North Carolina (14556) and active in the NPI registry since April 2019. He maintains a secondary practice location in Ahoskie.

NPPES Registry Identity

NPI1215490966
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameXAVIER QUAMAINE LEE FULLERTONCredential: LPC-A, CRC
Location Address140 KIMEL PARK DR STE 101Winston Salem, NC 27103-6185
Mailing AddressPo Box 60447Charlotte, NC 28260-0447
Phone(336) 718-7280
Fax(336) 718-7290
Sole ProprietorNo
Enumeration DateApril 10, 2019
Last NPPES UpdateAugust 23, 20233 updates tracked since enumeration
NPPES CertifiedAugust 23, 2023
✔ NPI 1215490966 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in NC · 14556
Also ListedCounselor · ProfessionalTaxonomy 101YP2500X · License A14556 (NC)
Also ListedRehabilitation CounselorTaxonomy 225C00000X
140 KIMEL PARK DR STE 101, Winston Salem, NC 27103
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Secondary Practice Location 1

Location 1120 Health Center DrAhoskie, NC 27910-8161 · Phone (252) 332-3548 · Fax (252) 332-1665

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC, Oscar Health Plan of North Carolina, Inc, UnitedHealthcare.Insurance ›

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. BRITTANY NICOLE GRAALMAN LCSWA
Social Worker (Clinical)
140 KIMEL PARK DR STE 101
WINSTON SALEM, NC 27103
Forsyth County (336) 718-7280
KIMBERLY SIMONNE NELSON LCMHC
Counselor (Mental Health)
140 KIMEL PARK DR STE 101
WINSTON SALEM, NC 27103
Forsyth County (336) 718-7280
NOVANT HEALTH MEDICAL GROUP, LLC
Psychiatry & Neurology (Psychiatry)
140 KIMEL PARK DR STE 101
WINSTON SALEM, NC 27103
Forsyth County (336) 718-7280
ESTHER RUTH SWAN DO
Psychiatry & Neurology (Psychiatry)
140 KIMEL PARK DR STE 101
WINSTON SALEM, NC 27103
Forsyth County (336) 718-7280
RICHARD DEWITT JACKSON II M.D.
Psychiatry & Neurology (Psychiatry)
140 KIMEL PARK DR STE 101
WINSTON SALEM, NC 27103
Forsyth County (336) 718-7280
VALERIE DENISE WINKLER LCMHC, LCMHC-S, LPC
Counselor (Mental Health)
140 KIMEL PARK DR STE 101
WINSTON SALEM, NC 27103
Forsyth County (336) 718-7280

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Xavier Fullerton's NPI number?

The NPI number for Xavier Fullerton is 1215490966. It was assigned to this individual provider in the NPPES registry on April 10, 2019.

Where is Xavier Fullerton located?

Xavier Fullerton practices at 140 Kimel Park Dr Ste 101, Winston Salem, NC 27103. The listed phone number is (336) 718-7280.

What is Xavier Fullerton's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

What insurance does Xavier Fullerton accept?

Health plans from Blue Cross and Blue Shield of NC, Oscar Health Plan of North Carolina, Inc and UnitedHealthcare list Xavier Fullerton as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Xavier Fullerton was last updated on August 23, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.