Marcella Fullilove, MS QMHP
Individual provider Active NPI Mental Health Counselor · Cairo, IL
NPI 1235669235 · NPPES record last updated Jun 13, 2017
Key facts
- NPI
- 1235669235
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 1401 Washington Ave
Cairo, IL 62914-1810 - Phone
- (618) 734-2665
- NPI assigned
- Jun 13, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
1401 Washington Ave
Cairo, IL 62914-1810
Mailing address
PO Box 1328
Vienna, IL 62995-1328
Phone (618) 658-3079
Other names
- Marcella Fullilove-Porter
Other providers in Cairo, IL
- Delta Center, Inc
- Delta Center, Inc
- Delta Center, Inc
- Delta Center, Inc
- Delta Center, Inc.
- Kara Goodman
- Rose Grundy
- Kyerra Henderson
- Melanie Hodge
- Kiana Lea Houston
All providers in Cairo, IL · Mental Health Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.