Healthcare Provider Details

I. General information

NPI: 1497673628
Provider Name (Legal Business Name): FULL CIRCLE COUNSELING AND WELLNESS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OLD WEST CHESTER PIKE
HAVERTOWN PA
19083-2712
US

IV. Provider business mailing address

2000 OLD WEST CHESTER PIKE
HAVERTOWN PA
19083-2712
US

V. Phone/Fax

Practice location:
  • Phone: 484-454-8700
  • Fax: 484-454-8700
Mailing address:
  • Phone: 484-454-8700
  • Fax: 484-454-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KEVIN OLIVO
Title or Position: EXECUTIVE VP
Credential:
Phone: 484-454-8700