Individual
MS. PENNY LOUISE POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SUDCC
Contact information
Practice address
1770 CEDAR ST., ROCKLEDGE, FL 32955
(321) 890-1500
(707) 526-0527
Mailing address
349 HARMONY PLACE, COCOA, FL 32926
(707) 280-1705
(707) 526-0527
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12872-R
CA
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
CA
Other
Enumeration date
01/17/2018
Last updated
01/25/2022
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