Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Xavier Quamaine Lee Fullerton, LPC-A, CRC

Individual provider Professional Counselor · NPI 1215490966

Xavier Quamaine Lee Fullerton, LPC-A, CRC is a Professional Counselor in Winston Salem, North Carolina. Works from 2 locations. Licensed in North Carolina.

Licensed in
NC
In the registry since
2019
Specialties on file
3

Practice location Address checks out

140 Kimel Park Dr Ste 101
Winston Salem, NC 27103-6185
Phone: (336) 718-7280
Fax: (336) 718-7290
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 120 Health Center Dr, Ahoskie, NC 27910-8161 — (252) 332-3548

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence 14556 (NC)
Professional Counselor Taxonomy 101YP2500X · Licence A14556 (NC)
Rehabilitation Counselor Taxonomy 225C00000X

Record details

NPI number1215490966
Entity typeIndividual (Type 1)
GenderMale
Credentials LPC-A , CRC
Sole proprietorNo
NPI enumeratedApril 10, 2019
Last updated in NPPESAugust 23, 2023
Certification dateAugust 23, 2023

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