Provider Demographics
NPI:1952995094
Name:POTTER, LARAE VERNITA
Entity Type:Individual
Prefix:MRS
First Name:LARAE
Middle Name:VERNITA
Last Name:POTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LARAE
Other - Middle Name:VERNITA
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:815 CLARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288
Mailing Address - Country:US
Mailing Address - Phone:315-572-6026
Mailing Address - Fax:
Practice Address - Street 1:815 CLARKWAY AVE
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288
Practice Address - Country:US
Practice Address - Phone:315-572-6026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health