Provider Demographics
NPI:1902378680
Name:UNLEASHING POTENTIAL LLC
Entity Type:Organization
Organization Name:UNLEASHING POTENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-831-7989
Mailing Address - Street 1:316 CHAMBORLEY DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-6149
Mailing Address - Country:US
Mailing Address - Phone:443-831-7989
Mailing Address - Fax:
Practice Address - Street 1:11100 LIBERTY RD STE G
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-1054
Practice Address - Country:US
Practice Address - Phone:443-831-7989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health