Provider Demographics
NPI:1093413221
Name:POTTER, ALEXIS (RBT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 HALL ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-2351
Mailing Address - Country:US
Mailing Address - Phone:423-707-9071
Mailing Address - Fax:
Practice Address - Street 1:470 WATER ST
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:TN
Practice Address - Zip Code:37861-3437
Practice Address - Country:US
Practice Address - Phone:865-828-5614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician