Provider Demographics
NPI:1508269911
Name:UNLOCKED POTENTIAL, LLC
Entity Type:Organization
Organization Name:UNLOCKED POTENTIAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-718-9428
Mailing Address - Street 1:331 DORN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1117
Mailing Address - Country:US
Mailing Address - Phone:732-718-9428
Mailing Address - Fax:
Practice Address - Street 1:331 DORN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1117
Practice Address - Country:US
Practice Address - Phone:732-718-9428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05408800251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health