Provider Demographics
NPI:1295226876
Name:POTTER, SALENA BLACKBURN (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:SALENA
Middle Name:BLACKBURN
Last Name:POTTER
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ARAB
Mailing Address - State:AL
Mailing Address - Zip Code:35016-1006
Mailing Address - Country:US
Mailing Address - Phone:256-682-0500
Mailing Address - Fax:
Practice Address - Street 1:34 N MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:ARAB
Practice Address - State:AL
Practice Address - Zip Code:35016-1240
Practice Address - Country:US
Practice Address - Phone:256-541-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-19
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALA177106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist