Provider Demographics
NPI:1558100636
Name:FULL CIRCLE WELLNESS, PLLC
Entity type:Organization
Organization Name:FULL CIRCLE WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:JACOBS
Authorized Official - Last Name:DEESE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:919-619-7379
Mailing Address - Street 1:3908 ASHTON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6844
Mailing Address - Country:US
Mailing Address - Phone:919-619-7379
Mailing Address - Fax:
Practice Address - Street 1:6416 CARMEL RD STE 408
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8268
Practice Address - Country:US
Practice Address - Phone:980-428-9174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1053153254OtherNPI