Provider Demographics
NPI:1487838520
Name:PEOPLE OF POTENTIAL, INC
Entity Type:Organization
Organization Name:PEOPLE OF POTENTIAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-265-1756
Mailing Address - Street 1:1703 COUNTRY CLUB RD STE 305
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6006
Mailing Address - Country:US
Mailing Address - Phone:901-989-1224
Mailing Address - Fax:910-938-0045
Practice Address - Street 1:1703 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 305
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6008
Practice Address - Country:US
Practice Address - Phone:901-989-1224
Practice Address - Fax:910-938-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301274BMedicaid