Individual
MS. ASHANTI IDA POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2575 NW KLINE ST., ROSEBURG, OR 97471
(541) 673-3504
Mailing address
2575 NW KLINE ST, ROSEBURG, OR 97471-8827
(541) 673-3504
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RG600X5Y
—
OR
Enumeration date
02/16/2021
Last updated
02/12/2026
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