Individual
ROBERT POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LASAC
Contact information
Practice address
1630 SHOUP ST, PRESCOTT, AZ 86305-1343
(928) 277-2448
Mailing address
PO BOX 12443, PRESCOTT, AZ 86304-2443
(928) 380-1526
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
08/20/2014
Last updated
08/20/2014
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