| Entity Name: | DYEANNA FULLER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 30 May 2019 (6 years ago) |
| Document Number: | L19000144463 |
| FEI/EIN Number | 84-2940881 |
| Address: | 1600 W EAU GALLIE BLVD, 201 F, MELBOURNE, FL, 32935, US |
| Mail Address: | 1600 W EAU GALLIE BLVD, 201 F, MELBOURNE, FL, 32935, US |
| ZIP code: | 32935 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073147427 | 2020-02-25 | 2020-02-25 | 1600 W EAU GALLIE BLVD STE 201F, MELBOURNE, FL, 329354149, US | 1600 W EAU GALLIE BLVD STE 201F, MELBOURNE, FL, 329354149, US | |||||||||||||
|
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| Phone | +1 561-740-5350 |
Authorized person
| Name | DYEANNA FULLER |
| Role | PROVIDER |
| Phone | 5614416466 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| FULLER DYEANNA L | Agent | 1600 W.EAU GALLIE BLVD, MELBOURNE, FL, 32935 |
| Name | Role | Address |
|---|---|---|
| Fuller Dyeanna L | Lice | 1600 W EAU GALLIE BLVD, MELBOURNE, FL, 32935 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-03-17 | 1600 W EAU GALLIE BLVD, 201 F, MELBOURNE, FL 32935 | No data |
| CHANGE OF MAILING ADDRESS | 2020-03-17 | 1600 W EAU GALLIE BLVD, 201 F, MELBOURNE, FL 32935 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-02 |
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-23 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-03-17 |
| Florida Limited Liability | 2019-05-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
