Provider Demographics
NPI:1275866493
Name:POTTER, CHRISTINA GENTILE (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:GENTILE
Last Name:POTTER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 ECHOTA AVE NE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-9024
Mailing Address - Country:US
Mailing Address - Phone:404-395-0515
Mailing Address - Fax:
Practice Address - Street 1:198 ECHOTA AVE NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-9024
Practice Address - Country:US
Practice Address - Phone:404-395-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW007635104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker