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Organization

THE POTTER'S HOUSE SUBSTANCE ABUSE CENTER

Active
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Organization

THE POTTER'S HOUSE SUBSTANCE ABUSE CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. SHEENA ROSETTE JONES (VICE PRESIDENT)
(602) 254-9701
Entity
Organization

Contact information

Practice address
1717 W NORTHERN AVE STE 101, PHOENIX, AZ 85021-5400
(602) 254-9701
(602) 252-0830
Mailing address
1717 W NORTHERN AVE STE 101, PHOENIX, AZ 85021-5400
(602) 254-9701
(602) 252-0830

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
251S00000X
Community/Behavioral Health Agency
BH3520
AZ
251S00000X
Community/Behavioral Health Agency
Primary
261QR0400X
Rehabilitation Clinic/Center
LISAC-10784
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
004477
AZ
01
1225147960
NPI
AZ
Enumeration date
08/29/2006
Last updated
10/22/2019
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