Provider Demographics
NPI:1366180531
Name:FULLER, CLAIRE (LGSW, LMSW)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:LGSW, LMSW
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7412 GEORGIA AVE NW STE 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1754
Mailing Address - Country:US
Mailing Address - Phone:202-283-1690
Mailing Address - Fax:
Practice Address - Street 1:7412 GEORGIA AVE NW STE 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1754
Practice Address - Country:US
Practice Address - Phone:202-283-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28537101YM0800X
DCLG200001598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health