Provider Demographics
NPI:1912402256
Name:FULL POTENTIAL MANAGEMENT, LLC
Entity type:Organization
Organization Name:FULL POTENTIAL MANAGEMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:KROVIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-476-5177
Mailing Address - Street 1:121 ALHAMBRA PLZ STE 1100
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4522
Mailing Address - Country:US
Mailing Address - Phone:305-476-5177
Mailing Address - Fax:305-461-4999
Practice Address - Street 1:121 ALHAMBRA PLZ STE 1100
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4522
Practice Address - Country:US
Practice Address - Phone:305-476-5177
Practice Address - Fax:305-461-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty