Provider Demographics
NPI:1730656539
Name:POTTS, CHRISTY ELIZABETH
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:ELIZABETH
Last Name:POTTS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHRISTY
Other - Middle Name:ELIZABETH
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:811 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4025
Mailing Address - Country:US
Mailing Address - Phone:925-314-5767
Mailing Address - Fax:
Practice Address - Street 1:811 SAN RAMON VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4025
Practice Address - Country:US
Practice Address - Phone:925-314-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician