Provider Demographics
NPI:1598801169
Name:POTTER, SHAWNA S
Entity Type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:S
Last Name:POTTER
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 1:972 EMILY LN
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4140
Mailing Address - Country:US
Mailing Address - Phone:931-510-0501
Mailing Address - Fax:
Practice Address - Street 1:1420 NEAL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4333
Practice Address - Country:US
Practice Address - Phone:931-525-6925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health