Full Potential,LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

MHL026799 Issued in NC

Legal business name

FULL POTENTIAL,LLC

Practice address

7238 Pebblebrook Dr
Fayetteville, NC 28314-5232

Phone

(910) 670-1989

NPI assigned

Feb 8, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Jerome S Johnson, BA

Title

Co-Director

Phone

(910) 670-1989

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Full Potential at Pembroke3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Full Potential LLC

  • Community/Behavioral Health Agency
  • Fayetteville, NC
  • NPI 1922236140
  NPD tax ID
• Full Potential, LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Lumberton, NC
  • NPI 1083747828
  NPD tax ID

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639219348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25681",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283145011",
            "telephone_number": "910-670-1989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7238 PEBBLEBROOK DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283145232",
            "telephone_number": "910-670-1989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL POTENTIAL,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CO-DIRECTOR",
        "authorized_official_telephone_number": "910-670-1989",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL026799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603827",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Andrade Fuentes
• Belinda Kaydianne Fugalli, PA-C
• Megan Fulden
• Full Circle Therapeutic Services, PLLC
• Full Potential LLC
• Angel Marie Fuller, LCSW-A
• Daphne Fuller, LPC
• Eliza A Fuller
• Lisa Lynn Fuller, MPT
• Marlisa Fuller

• Mental Illness Community Based Residential Treatment Facility in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Mental Illness Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.