Provider Demographics
NPI:1568801991
Name:POTTS, JASMINE MARIA (LPC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:MARIA
Last Name:POTTS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8406 SIX FORKS RD
Mailing Address - Street 2:STE. 204
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3074
Mailing Address - Country:US
Mailing Address - Phone:919-617-9656
Mailing Address - Fax:
Practice Address - Street 1:8406 SIX FORKS RD
Practice Address - Street 2:STE. 204
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3074
Practice Address - Country:US
Practice Address - Phone:919-617-9656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health