Provider Demographics
NPI:1649584335
Name:POTTS, THERESA B (LCSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:B
Last Name:POTTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 COVERED BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3104
Mailing Address - Country:US
Mailing Address - Phone:856-304-0584
Mailing Address - Fax:
Practice Address - Street 1:412 COVERED BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3104
Practice Address - Country:US
Practice Address - Phone:856-304-0584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04860001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical