Provider Demographics
NPI:1386962769
Name:POTEAT, JOWAHN DENEL
Entity type:Individual
Prefix:
First Name:JOWAHN
Middle Name:DENEL
Last Name:POTEAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HOPPE BLVD.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-436-7211
Mailing Address - Fax:580-272-5757
Practice Address - Street 1:1300 HOPPE BLVD.
Practice Address - Street 2:SUITE 4
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820
Practice Address - Country:US
Practice Address - Phone:580-272-5170
Practice Address - Fax:580-421-8772
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)