Provider Demographics
NPI:1386935732
Name:FULLER-BARNARD, PAATRICIA ANN (MAC, MS)
Entity type:Individual
Prefix:MRS
First Name:PAATRICIA
Middle Name:ANN
Last Name:FULLER-BARNARD
Suffix:
Gender:F
Credentials:MAC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 PINE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7030
Mailing Address - Country:US
Mailing Address - Phone:386-313-1283
Mailing Address - Fax:
Practice Address - Street 1:81 PINE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164
Practice Address - Country:US
Practice Address - Phone:386-313-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health