Provider Demographics
NPI:1992831044
Name:POTTS METZKER, CAROLYN J (LPC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:POTTS METZKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1163
Mailing Address - Country:US
Mailing Address - Phone:541-488-7957
Mailing Address - Fax:541-488-7957
Practice Address - Street 1:565 A ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2063
Practice Address - Country:US
Practice Address - Phone:541-778-6518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1792101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional