Individual provider · Type 1 NPI

Diane Fultz, LCDCII, SWA, QMHS

Addiction (Substance Use Disorder) Counselor · Mentor, OH

NPI number 1780197756 Active

Practice location

7232 Justin Way
Mentor, OH 44060-4881

Specialties and licenses

TaxonomyCodeLicense
Case Manager/Care Coordinator 171M00000XW.1300044 (OH)
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XLCDCII.161560 (OH)

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About NPI 1780197756

Diane Fultz, LCDCII, SWA, QMHS's National Provider Identifier is 1780197756, issued on Nov 13, 2017. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Mentor, OH. The record was last updated on Oct 24, 2021.