Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003073099 |
---|---|
Provider Name | Mrs. Carol Potter |
First Address | Phoenix, AZ 85015-5101 |
Second Address | Phoenix, AZ 85006-2102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2008 |
Last Update Date | 19/05/2008 |