Provider Demographics
NPI:1720795958
Name:KONDRA FULMER COUNSELING, LLC
Entity type:Organization
Organization Name:KONDRA FULMER COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KONDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FULMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-332-1498
Mailing Address - Street 1:12802 PISCATAWAY LANDING DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4591
Mailing Address - Country:US
Mailing Address - Phone:301-332-1498
Mailing Address - Fax:
Practice Address - Street 1:12802 PISCATAWAY LANDING DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4591
Practice Address - Country:US
Practice Address - Phone:301-332-1498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health