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General NPI Number Information
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NPI Number | 1659829133
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Entity Type | Organization
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Legal Business Name | FULL CIRCLE THERAPIES, LLC
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 119 VIVAS DR
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City | BARNEGAT
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State | NJ
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Zip | 08005-2593
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Country | US
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Telephone | 732-867-8765
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Fax |
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Provider Business Mailing Address
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Address Line | 119 VIVAS DR
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City | BARNEGAT
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State | NJ
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Zip | 08005-2593
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Country | US
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Telephone | 732-867-8765
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KATIE PATRICIA DAVIS
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Credential | LCSW
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Telephone | 732-861-8765
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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 | 44SC05188000
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License Number State | NJ
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