Provider Demographics
NPI:1609462480
Name:POTTHAST, ANA ALICIA AMORICITY (DSW, LCSW, LCDC)
Entity Type:Individual
Prefix:DR
First Name:ANA ALICIA
Middle Name:AMORICITY
Last Name:POTTHAST
Suffix:
Gender:F
Credentials:DSW, LCSW, LCDC
Other - Prefix:DR
Other - First Name:ANA
Other - Middle Name:ALICIA
Other - Last Name:PEREZ-INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DSW, LCSW, LCDC
Mailing Address - Street 1:667 ARROYO SIERRA
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-0190
Mailing Address - Country:US
Mailing Address - Phone:210-508-4688
Mailing Address - Fax:
Practice Address - Street 1:667 ARROYO SIERRA
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-0190
Practice Address - Country:US
Practice Address - Phone:210-508-4688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15054101YA0400X
TX59774101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15054OtherLICENSED CHEMICAL DEPENDENCY COUNSELOR
TX59774OtherLICENSED CLINICAL SOCIAL WORKER