Provider Demographics
NPI:1326623562
Name:POTTER, RANDALL STEVEN
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:STEVEN
Last Name:POTTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 4TH AVE STE 1801
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-1716
Mailing Address - Country:US
Mailing Address - Phone:833-274-4325
Mailing Address - Fax:
Practice Address - Street 1:239 4TH AVE STE 1801
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-1716
Practice Address - Country:US
Practice Address - Phone:833-274-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health