Provider Demographics
NPI:1801386230
Name:FULLER, JENNIFER (LPC, LAC, AADC, NCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:LPC, LAC, AADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 CRITTENDEN ST UNIT 243
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-7787
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 CRITTENDEN ST UNIT 243
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-7787
Practice Address - Country:US
Practice Address - Phone:870-260-9106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6149101YP2500X
MO2018009719101YP2500X
GA012455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional