Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 30839 | CA |
Y | 103T00000X | Psychologist | 30839 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 30839 | CA |
N | 103TC1900X | Counseling Psychologist | 30839 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 30839 | CA |
N | 103TF0000X | Family Psychologist | 30839 | CA |
N | 103TS0200X | School Psychologist | 30839 | CA |
NPI | 1205430444 |
---|---|
Provider Name | Dr. Andrew Potter |
First Address | Pinole, CA 94564-1527 |
Second Address | Walnut Creek, CA 94596-5314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2020 |
Last Update Date | 29/11/2020 |