Provider Demographics
NPI:1346540689
Name:POTTER, ROBIN HAGER (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:HAGER
Last Name:POTTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2720
Mailing Address - Country:US
Mailing Address - Phone:423-929-3834
Mailing Address - Fax:
Practice Address - Street 1:1507 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2720
Practice Address - Country:US
Practice Address - Phone:423-929-3834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8689104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker