Provider Demographics
NPI:1891467593
Name:UNLIMITED POTENTIAL THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:UNLIMITED POTENTIAL THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LICSW, PIP
Authorized Official - Phone:334-546-5752
Mailing Address - Street 1:6533 BERRYDALE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-4363
Mailing Address - Country:US
Mailing Address - Phone:334-546-5752
Mailing Address - Fax:
Practice Address - Street 1:6533 BERRYDALE DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-4363
Practice Address - Country:US
Practice Address - Phone:334-546-5752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty