Provider Demographics
NPI:1245329077
Name:POTTER, CARL LEWIS III (LCSW)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:LEWIS
Last Name:POTTER
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-2207
Mailing Address - Country:US
Mailing Address - Phone:919-304-5614
Mailing Address - Fax:
Practice Address - Street 1:5003 SOUTHPARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9414
Practice Address - Country:US
Practice Address - Phone:919-493-6329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0038341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC128E6Medicare UPIN