Provider Demographics
NPI:1386294478
Name:FULFORD, SAVANNAH (LMHC)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:FULFORD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3094 NE HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-7240
Mailing Address - Country:US
Mailing Address - Phone:863-221-2370
Mailing Address - Fax:
Practice Address - Street 1:900 SE OCEAN BLVD STE D232
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3501
Practice Address - Country:US
Practice Address - Phone:772-678-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16494101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health