Martia Jeronda Fuller

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

A14117 Issued in NC

Practice address

8401 Medical Plaza Dr Ste 360
Charlotte, NC 28262-8700

Phone

(704) 208-4458

Fax

(866) 309-6385

NPI assigned

Oct 14, 2018

Last updated

Jan 3, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Anderson Counseling and Consulting Group, PLLC

  • Community/Behavioral Health Agency
  • Charlotte, NC
  • NPI 1629416029

  Professional

  NPD (past)

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

{
    "created_epoch": "1539475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578009600000",
    "number": "1780150011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 SYCAMORE ST",
            "city": "OXFORD",
            "state": "NC",
            "postal_code": "275653625",
            "telephone_number": "919-339-0649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 MEDICAL PLAZA DR STE 360",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282628700",
            "telephone_number": "704-208-4458",
            "fax_number": "866-309-6385"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1788 Heritage Center Dr Ste 202",
            "address_purpose": "LOCATION",
            "city": "Wake Forest",
            "state": "NC",
            "postal_code": "275873972",
            "country_code": "US",
            "telephone_number": "919-435-7920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "MARTIA",
        "middle_name": "JERONDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-14",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "A14117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Lauren Fuller
• Denisha Fuller
• Devonte Fuller
• Donta' C Fuller
• Lasheree Fuller
• Nancy Fuller, LAC
• Peggy A Fuller, MD
• Fullscope Counseling Services
• Erika Fulop, PA-C
• Sam R Fulp, M.D.

• Professional Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; 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.