Healthcare Provider Details

I. General information

NPI: 1699516963
Provider Name (Legal Business Name): TRUE POTENTIAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 FRANKLIN TURNPIKE STE 10
DANVILLE VA
24540
US

IV. Provider business mailing address

2725 FRANKLIN TPKE STE F
DANVILLE VA
24540-5365
US

V. Phone/Fax

Practice location:
  • Phone: 804-930-4720
  • Fax:
Mailing address:
  • Phone: 804-930-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: FEDENA WADE
Title or Position: MEMBER
Credential:
Phone: 804-930-4720