MEDICARE: FULL FOCUS TRAINING CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	251S00000X	Community/Behavioral Health Agency	VA
2	261QR0400X	Rehabilitation Clinic/Center	VA
3	261QM0850X	Adult Mental Health Clinic/Center	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013407659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL FOCUS TRAINING CENTER LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 213
Second Line	:
City	:	WAVERLY
State	:	VA
Zip	:	23890-0213
Country	:	US
Telephone Number	:	804-834-1100
Fax Number	:	804-834-2200

Provider Business Practice Location Address
First Line	:	1863 FORT MAHONE ST
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2761
Country	:	US
Telephone Number	:	804-834-1100
Fax Number	:	804-834-2200

Authorized Official
Title or Position	:	OWNER/PROGRAM DIRECTOR
Name	:	LESLEY TUCKER
Credential	:	MS
Telephone Number	:	804-895-2106

Provider Enumeration Date	:	05/17/2018
Last Update Date	:	09/11/2025

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Directions to “FULL FOCUS TRAINING CENTER LLC ” Practice Location

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