Provider Demographics
NPI:1598718777
Name:POTTER, WILLIAM HOLLIS (LPC, LCAS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HOLLIS
Last Name:POTTER
Suffix:
Gender:M
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2187 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:OLD FORT
Mailing Address - State:NC
Mailing Address - Zip Code:28762-8836
Mailing Address - Country:US
Mailing Address - Phone:828-668-9565
Mailing Address - Fax:
Practice Address - Street 1:440 E COURT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-1864
Practice Address - Country:US
Practice Address - Phone:828-659-8626
Practice Address - Fax:828-659-6383
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC551101YA0400X
NC4731101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC138GJOtherBLUE CROSS BLUE SHIELD
NC6102008Medicaid