Individual
ETHAN POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LLMSW
Contact information
Practice address
790 FULLER AVE NE, GRAND RAPIDS, MI 49503
(616) 336-3909
Mailing address
790 FULLER AVE NE, GRAND RAPIDS, MI 49503
(616) 336-3909
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
11/19/2024
Last updated
11/19/2024
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