Provider Demographics
NPI:1851517288
Name:POTTER, SANDRA KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:POTTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:16310 ARBOR DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-2936
Mailing Address - Country:US
Mailing Address - Phone:469-774-9586
Mailing Address - Fax:
Practice Address - Street 1:16310 ARBOR DOWNS DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-2936
Practice Address - Country:US
Practice Address - Phone:469-774-9586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical