Provider Demographics
NPI:1689625444
Name:POTTER, DARILOU DEE (NCC-BC LPC LMHC)
Entity Type:Individual
Prefix:
First Name:DARILOU
Middle Name:DEE
Last Name:POTTER
Suffix:
Gender:F
Credentials:NCC-BC LPC LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4743 FIR DELL DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4812
Mailing Address - Country:US
Mailing Address - Phone:503-332-6134
Mailing Address - Fax:
Practice Address - Street 1:1675 WINTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97303
Practice Address - Country:US
Practice Address - Phone:503-585-0351
Practice Address - Fax:503-585-0212
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006910101YM0800X
ORC1643101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health