Provider Demographics
NPI:1518739853
Name:POTIS, DANIELLE MEGAN
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MEGAN
Last Name:POTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5673 PHELPS LUCK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2527
Mailing Address - Country:US
Mailing Address - Phone:443-204-7212
Mailing Address - Fax:
Practice Address - Street 1:5673 PHELPS LUCK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2527
Practice Address - Country:US
Practice Address - Phone:443-774-0767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13430101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health