Provider Demographics
NPI:1841705043
Name:POTTER, CYNTHIA (MA, LISAC, CSP, NCC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:MA, LISAC, CSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10630 N THUNDER HILL PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-7006
Mailing Address - Country:US
Mailing Address - Phone:520-954-5454
Mailing Address - Fax:
Practice Address - Street 1:10630 N THUNDER HILL PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85737-7006
Practice Address - Country:US
Practice Address - Phone:520-954-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-10
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ155307101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty