Provider Demographics
NPI:1386154474
Name:FULL CIRCLE FLORIDA INC.
Entity type:Organization
Organization Name:FULL CIRCLE FLORIDA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLI
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUM
Authorized Official - Suffix:
Authorized Official - Credentials:LHMC
Authorized Official - Phone:407-801-9628
Mailing Address - Street 1:6396 ROYAL TERN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6396 ROYAL TERN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6012
Practice Address - Country:US
Practice Address - Phone:407-801-9628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15156101YM0800X
FL101YM0800X, 171M00000X, 172V00000X, 251B00000X, 405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty