Provider Demographics
NPI:1396280020
Name:JENNIFER K. POTTS THERAPY LLC
Entity type:Organization
Organization Name:JENNIFER K. POTTS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LGADC, CRC
Authorized Official - Phone:443-523-0559
Mailing Address - Street 1:111 QUIET WATERS PL
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-2705
Mailing Address - Country:US
Mailing Address - Phone:443-523-0559
Mailing Address - Fax:
Practice Address - Street 1:111 QUIET WATERS PL
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-2705
Practice Address - Country:US
Practice Address - Phone:443-523-0559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7436302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization