Provider Demographics
NPI:1780127167
Name:FULL CIRCLE THERAPY SERVICES LLC
Entity type:Organization
Organization Name:FULL CIRCLE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:301-971-4096
Mailing Address - Street 1:7764 MANDAN RD
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2167
Mailing Address - Country:US
Mailing Address - Phone:301-971-4096
Mailing Address - Fax:
Practice Address - Street 1:4404 QUEENSBURY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1068
Practice Address - Country:US
Practice Address - Phone:301-971-4096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500802141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty