Provider Demographics
NPI:1730413998
Name:POTTS, MARK A (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:POTTS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:BLDG 4-3219 ROOM #G091, 2817 REILLY STREET
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-9191
Mailing Address - Fax:
Practice Address - Street 1:DOBH CHILD AND FAMILY CLINIC 2817 REILLY STREET
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-1343
Practice Address - Country:US
Practice Address - Phone:910-907-9191
Practice Address - Fax:910-907-4201
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040072171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical