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General NPI Number Information
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NPI Number | 1013407659
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Entity Type | Organization
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Legal Business Name | FULL FOCUS TRAINING CENTER LLC
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1863 FORT MAHONE ST
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City | PETERSBURG
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State | VA
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Zip | 23805-2761
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Country | US
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Telephone | 804-834-1100
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Fax | 804-834-2200
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Provider Business Mailing Address
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Address Line | P.O. BOX 213
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City | WAVERLY
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State | VA
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Zip | 23890-0213
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Country | US
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Telephone | 804-834-1100
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Fax | 804-834-2200
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Authorized Official
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Title or Position | OWNER/PROGRAM DIRECTOR
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Name | LESLEY TUCKER
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Credential | MS
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Telephone | 804-895-2106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | VA
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