Full Potential Youth Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

SS36507 Issued in VA

Legal business name

FULL POTENTIAL YOUTH SERVICES

Practice address

18 Taylor Rd
Richmond, VA 23223-5532

Phone

(804) 222-3510

NPI assigned

Jan 15, 2008

Last updated

Jan 15, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. James Broadnax Harris Jr.

Title

Chief Administration Officer

Phone

(804) 837-4492

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200355200000",
    "number": "1366628760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13107 LIBERTY POINT PL",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231127000",
            "telephone_number": "804-222-3510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 TAYLOR RD",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232235532",
            "telephone_number": "804-222-3510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL POTENTIAL YOUTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-15",
        "last_updated": "2008-01-15",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "BROADNAX",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATION OFFICER",
        "authorized_official_telephone_number": "804-837-4492",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "VA",
            "license": "SS36507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vickie Dee Fulkerson, FNP-C
• Betsy Guedri Fulks, RPH
• Full Circle Grief Center
• Full Circle Health Care
• Full Moon Pediatric Therapy LLC
• Courtney Midgette Fuller, R.PH.
• Frank Bernard Fuller III, PHARMD
• James Woodrow Fuller Jr., PH.D., LCSW
• Latosha Fuller
• Nicholas Grey Fuller, RN

• Community/Behavioral Health Agency in Richmond, VA
• Providers in Richmond, VA by specialty
• Community/Behavioral Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.