Provider Demographics
NPI:1194386821
Name:POTTS, MARIA ANNE (MA, LCAS-A)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANNE
Last Name:POTTS
Suffix:
Gender:F
Credentials:MA, LCAS-A
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:ANNE
Other - Last Name:POTTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MARIA ANNE POTTS
Mailing Address - Street 1:615 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6431
Mailing Address - Country:US
Mailing Address - Phone:910-216-6080
Mailing Address - Fax:910-202-3862
Practice Address - Street 1:615 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6431
Practice Address - Country:US
Practice Address - Phone:910-216-6080
Practice Address - Fax:910-202-3862
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24829101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)