Provider Demographics
NPI:1659097525
Name:PIVOTS POTENTIAL
Entity type:Organization
Organization Name:PIVOTS POTENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:VIDA LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENN-LEON
Authorized Official - Suffix:
Authorized Official - Credentials:LSCW
Authorized Official - Phone:410-868-3498
Mailing Address - Street 1:1631 WESEL BLVD # 1047
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5387
Mailing Address - Country:US
Mailing Address - Phone:888-458-5199
Mailing Address - Fax:240-337-8598
Practice Address - Street 1:917 HOFFMASTER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:MD
Practice Address - Zip Code:21758-1216
Practice Address - Country:US
Practice Address - Phone:888-458-5199
Practice Address - Fax:240-337-8598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty