| Dyeanna Fuller Llc | |
|
1600 W Eau Gallie Blvd Ste 201f Melbourne FL 32935-4149 | |
| (561) 740-5350 | |
| Not Available |
| Full Name | Dyeanna Fuller Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1600 W Eau Gallie Blvd Ste 201f, Melbourne, Florida |
| Authorized Official Name and Position | Dyeanna Fuller (PROVIDER) |
| Authorized Official Contact | 5614416466 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dyeanna Fuller Llc 1600 W Eau Gallie Blvd Ste 201f Melbourne FL 32935-4149 Ph: () - | Dyeanna Fuller Llc 1600 W Eau Gallie Blvd Ste 201f Melbourne FL 32935-4149 Ph: (561) 740-5350 |
| NPI Number | 1073147427 |
|---|---|
| Provider Enumeration Date | 02/25/2020 |
| Last Update Date | 02/25/2020 |
| Certification Date | 02/25/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073147427 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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