Most Relevant Information
Provider Data
| NPI Number: | 1003241209 |
| Provider Name: | SHANNON NOELLE FULCROD LCSW, CSAC, MAC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 0710102773 |
Most Important Dates
| Enumeration Date: | 09/06/2013 |
| Last Updated: | 11/07/2024 |
Provider Practice Location
9300 DEWITT LOOP
FORT BELVOIR
VA
220605285
Practice Location Phone/Fax
| Phone: | 5712311200 |
| Fax: |
Provider Mailing Location
9532 AIRDRIE LN
FREDERICKSBURG
VA
224089521
Provider Mailing Phone/Fax
| Phone: | 5407608985 |
| Fax: |