Healthcare Provider Details

I. General information

NPI: 1871990291
Provider Name (Legal Business Name): FULL POTENTIAL HEALTH AND WELLNESS, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120B KINGSTON DR
CHAPEL HILL NC
27514-1630
US

IV. Provider business mailing address

PO BOX 17102
CHAPEL HILL NC
27516-7102
US

V. Phone/Fax

Practice location:
  • Phone: 941-224-6256
  • Fax:
Mailing address:
  • Phone: 941-224-6256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: LEAH GIBBONS
Title or Position: PRESIDENT, CERTIFIED HEALTH COACH
Credential: MS, CHC
Phone: 941-224-6256