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NINA VANBROCKLIN FULLER LCPC-C
Professional >> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1124423413
Individual Registrant: NINA VANBROCKLIN FULLER LCPC-C
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
335 LITTLE FALLS RD HOLLIS CENTER, ME 04042-3921 US
Tel: 207-650-8963 Fax: --
Tel: 207-650-8963 Fax: --
Contact information for business:
335 LITTLE FALLS RD HOLLIS CENTER, ME 04042-3921 US
Tel: 207-650-8963 Fax: --
Tel: 207-650-8963 Fax: --
Registration Information:
NPI: 1124423413
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 101YP2500X | Behavioral Health & Social Service Providers Counselor Professional | ME | XL4326 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
