Provider Demographics
NPI:1265749253
Name:POTTS, STACY DANIELLE (MSW, LISW)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:DANIELLE
Last Name:POTTS
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:MS
Other - First Name:STACY
Other - Middle Name:DANIELLE
Other - Last Name:POPOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LISW-S
Mailing Address - Street 1:420 N JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1834
Mailing Address - Country:US
Mailing Address - Phone:614-452-0133
Mailing Address - Fax:614-257-5205
Practice Address - Street 1:420 N JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1834
Practice Address - Country:US
Practice Address - Phone:614-580-6486
Practice Address - Fax:614-257-5205
Is Sole Proprietor?:No
Enumeration Date:2010-09-12
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 10001851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical