Fultz, Diane

Fultz, Diane is an sole proprietor health care provider with primary practice located at 7232 Justin Way , Mentor OH 44060-4881. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Case Manager/Care Coordinator, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Fultz, Diane can be contacted via phone (440) 578-8200.

Contact Information

Primary practice address
7232 Justin Way Mentor OH 44060-4881
Phone: (440) 578-8200
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Case Manager/Care Coordinator 171M00000X W.1300044 Ohio
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X LCDCII.161560 Ohio

Profile Details

NPI number 1780197756
LBN Legal business name Fultz, Diane
Credentials LCDCII, SWA, QMHS
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 13th, 2017
Last updated Oct 24th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780197756 NPPES
Ohio MEDICAID 0341565

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