Provider Demographics
NPI:1366977514
Name:FULTON, ROSALYN CONTINA (LCPC)
Entity type:Individual
Prefix:
First Name:ROSALYN
Middle Name:CONTINA
Last Name:FULTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 WADSWORTH WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-3109
Mailing Address - Country:US
Mailing Address - Phone:410-585-7227
Mailing Address - Fax:
Practice Address - Street 1:1812 WADSWORTH WAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-3109
Practice Address - Country:US
Practice Address - Phone:443-308-7048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA2538101YA0400X
MDLC8550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)