Brook Alexis Fulton-Delong, LCPC, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LC12594 Issued in MD

Practice address

8181 Main St Apt 2
Ellicott City, MD 21043-4929

Phone

(757) 651-3001

Fax

(757) 222-3833

NPI assigned

Jul 14, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Brook Alexis Fulton Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Village Counseling LLC

  • Clinical Social Worker
  • Ellicott City, MD
  • NPI 1306488655
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668556800000",
    "number": "1407464688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8181 MAIN ST APT 2",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210434929",
            "telephone_number": "410-505-0062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8181 MAIN ST APT 2",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210434929",
            "telephone_number": "757-651-3001",
            "fax_number": "757-222-3833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTON-DELONG",
        "first_name": "BROOK",
        "middle_name": "ALEXIS",
        "credential": "LCPC, NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-14",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LGP10581",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LC12594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROOK",
            "last_name": "FULTON",
            "middle_name": "ALEXIS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Ellicott City, MD
• Mental Health Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.