MEDICARE: FULL CIRCLE GRIEF CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1154809713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL CIRCLE GRIEF CENTER

Provider Business Mailing Address
First Line	:	10611 PATTERSON AVE STE 201
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-4733
Country	:	US
Telephone Number	:	804-912-2947
Fax Number	:

Provider Business Practice Location Address
First Line	:	10611 PATTERSON AVE STE 201
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-4733
Country	:	US
Telephone Number	:	804-912-2947
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ALLYSON DRAKE
Credential	:	M. ED., CT
Telephone Number	:	804-912-2947

Provider Enumeration Date	:	08/04/2018
Last Update Date	:	08/04/2018

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