Provider Demographics
NPI:1265741961
Name:FULL CIRLCE WELLNESS
Entity type:Organization
Organization Name:FULL CIRLCE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP
Authorized Official - Phone:248-722-2653
Mailing Address - Street 1:5600 W MAPLE RD STE A110
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3705
Mailing Address - Country:US
Mailing Address - Phone:248-722-2653
Mailing Address - Fax:248-855-4840
Practice Address - Street 1:5600 W MAPLE RD STE A110
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3705
Practice Address - Country:US
Practice Address - Phone:248-722-2653
Practice Address - Fax:248-855-4840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011714103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty