Provider Demographics
NPI:1609402551
Name:POTTS, CHAD (BCPC)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:POTTS
Suffix:
Gender:M
Credentials:BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 W PIKE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4843
Mailing Address - Country:US
Mailing Address - Phone:678-765-9291
Mailing Address - Fax:
Practice Address - Street 1:337 W PIKE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4843
Practice Address - Country:US
Practice Address - Phone:678-765-9291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-22
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01184773101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral