Provider Demographics
NPI:1881112415
Name:POTVIN, ANN-MICHELE CORBI (LPC, BC-DMT)
Entity type:Individual
Prefix:
First Name:ANN-MICHELE
Middle Name:CORBI
Last Name:POTVIN
Suffix:
Gender:F
Credentials:LPC, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 LONGRIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243
Mailing Address - Country:US
Mailing Address - Phone:215-498-8455
Mailing Address - Fax:
Practice Address - Street 1:615 WASHINGTON RD STE 206
Practice Address - Street 2:
Practice Address - City:MT LEBANON
Practice Address - State:PA
Practice Address - Zip Code:15228-1927
Practice Address - Country:US
Practice Address - Phone:215-498-8455
Practice Address - Fax:215-498-8455
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-04
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BC-DMT-1035225600000X
PAPC008410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist