Provider Demographics
NPI:1912291121
Name:POTTER, JANET M (LMFT, MLADC, LADC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:M
Last Name:POTTER
Suffix:
Gender:F
Credentials:LMFT, MLADC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-0206
Mailing Address - Country:US
Mailing Address - Phone:802-295-9800
Mailing Address - Fax:802-295-9889
Practice Address - Street 1:205 BILLINGS FARM RD., 1B-1
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001
Practice Address - Country:US
Practice Address - Phone:802-295-9800
Practice Address - Fax:802-295-9889
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0987101YA0400X, 101YM0800X
VT151.0127914101YA0400X
VT100.0057970106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT100.0057970OtherLMFT
VT151.0127914OtherLADC
NH0987OtherMLADC