Provider Demographics
NPI:1922236140
Name:FULL POTENTIAL LLC
Entity Type:Organization
Organization Name:FULL POTENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, PLCSW
Authorized Official - Phone:910-860-3855
Mailing Address - Street 1:PO BOX 25681
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5011
Mailing Address - Country:US
Mailing Address - Phone:910-860-3855
Mailing Address - Fax:
Practice Address - Street 1:308 HAY ST STE D
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5574
Practice Address - Country:US
Practice Address - Phone:910-860-3855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health