MARTIA JERONDA FULLER - NPI 1780150011 - Counselor in Charlotte, NC

Q: What is the provider's specialty?

The provider's specialty is Counselor with taxonomy code 101YP2500X and a focus in Professional.

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About Martia Jeronda Fuller NPPES

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

MARTIA JERONDA FULLER (NPI 1780150011) is an individual professional provider in Charlotte, North Carolina, licensed in North Carolina (A14117) and active in the NPI registry since October 2018. She maintains a secondary practice location in Wake Forest.

NPPES Registry Identity

NPI1780150011

Entity TypeIndividualFemale

Primary Taxonomy101YP2500X

Provider Legal NameMARTIA JERONDA FULLER

Location Address8401 MEDICAL PLAZA DR STE 360Charlotte, NC 28262-8700

Mailing Address204 Sycamore StOxford, NC 27565-3625 · (919) 339-0649

Phone(704) 208-4458

Fax(866) 309-6385

Sole ProprietorYes

Enumeration DateOctober 14, 2018

Last NPPES UpdateJanuary 3, 20202 updates tracked since enumeration

✔ NPI 1780150011 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in NC · A14117

8401 MEDICAL PLAZA DR STE 360, Charlotte, NC 28262

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Secondary Practice Location 1

Location 11788 Heritage Center Dr Ste 202Wake Forest, NC 27587-3972 · Phone (919) 435-7920

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

Other Providers at the Same Location NPPES 9

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

SHELIA DENISE CAMPBELL LPC-A

Counselor (Mental Health)