Provider Demographics
NPI:1154809713
Name:FULL CIRCLE GRIEF CENTER
Entity type:Organization
Organization Name:FULL CIRCLE GRIEF CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, CT
Authorized Official - Phone:804-912-2947
Mailing Address - Street 1:10611 PATTERSON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4733
Mailing Address - Country:US
Mailing Address - Phone:804-912-2947
Mailing Address - Fax:
Practice Address - Street 1:10611 PATTERSON AVE STE 201
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4733
Practice Address - Country:US
Practice Address - Phone:804-912-2947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-04
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty