Provider Demographics
NPI:1548746860
Name:POTTS, AMBER (LCMHCA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:POTTS
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 QUEEN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5527
Mailing Address - Country:US
Mailing Address - Phone:910-673-8552
Mailing Address - Fax:
Practice Address - Street 1:1608 QUEEN ST STE 1
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5527
Practice Address - Country:US
Practice Address - Phone:910-673-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NCA15609101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program