Provider Demographics
NPI:1417947045
Name:POTTER, NANCY DUTTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:DUTTON
Last Name:POTTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HIRST RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-6199
Mailing Address - Country:US
Mailing Address - Phone:703-674-8929
Mailing Address - Fax:
Practice Address - Street 1:205 HIRST RD
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6198
Practice Address - Country:US
Practice Address - Phone:703-674-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1081103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
075082OtherOPTIONS
099947000OtherMAGELLAN MIS
323312OtherTRICARE
VA078759OtherANTHEM BCBS TRIGOD
323312OtherMHN
4752OtherCAREFIRST BCBS
VA7700822Medicaid
323312OtherTRICARE