Organization
FULL POTENTIAL YOUTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES BROADNAX HARRIS JR. (CHIEF ADMINISTRATION OFFICER)
(804) 837-4492
Entity
Organization
Contact information
Practice address
18 TAYLOR RD, RICHMOND, VA 23223-5532
(804) 222-3510
Mailing address
13107 LIBERTY POINT PL, MIDLOTHIAN, VA 23112-7000
(804) 222-3510
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
SS36507
VA
Other
Enumeration date
01/15/2008
Last updated
01/15/2008
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