Provider Demographics
NPI:1164709135
Name:KIMBERLY, SUSAN POTTS (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:POTTS
Last Name:KIMBERLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:BETH
Other - Last Name:POTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:302 SUNSET CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4628
Mailing Address - Country:US
Mailing Address - Phone:703-254-4024
Mailing Address - Fax:888-972-1187
Practice Address - Street 1:6101 QUADRANGLE DR
Practice Address - Street 2:SUITE #100
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8655
Practice Address - Country:US
Practice Address - Phone:919-445-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0038501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical