Provider Demographics
NPI:1609769421
Name:POTTER, AMANDA M (CADC, MHRT-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:POTTER
Suffix:
Gender:F
Credentials:CADC, MHRT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5125
Mailing Address - Country:US
Mailing Address - Phone:207-572-6705
Mailing Address - Fax:
Practice Address - Street 1:13 BIRCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5125
Practice Address - Country:US
Practice Address - Phone:207-572-6705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 102X00000X, 106S00000X, 101YM0800X
MEAD9046101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health