Provider Demographics
NPI:1497566327
Name:POTENTIAL SPACE PLLC
Entity type:Organization
Organization Name:POTENTIAL SPACE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:BALDWIN
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:919-673-8287
Mailing Address - Street 1:18 W COLONY PL STE 140
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-5582
Mailing Address - Country:US
Mailing Address - Phone:919-673-8287
Mailing Address - Fax:
Practice Address - Street 1:18 W COLONY PL STE 140
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-5582
Practice Address - Country:US
Practice Address - Phone:919-673-8287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty