Provider Demographics
NPI:1871990291
Name:FULL POTENTIAL HEALTH AND WELLNESS, INCORPORATED
Entity type:Organization
Organization Name:FULL POTENTIAL HEALTH AND WELLNESS, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CERTIFIED HEALTH COACH
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CHC
Authorized Official - Phone:941-224-6256
Mailing Address - Street 1:PO BOX 17102
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-7102
Mailing Address - Country:US
Mailing Address - Phone:941-224-6256
Mailing Address - Fax:
Practice Address - Street 1:120B KINGSTON DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1630
Practice Address - Country:US
Practice Address - Phone:941-224-6256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty