Individual
MRS. NICOLE RENAE POTTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
151 SOUTHWEST DR, JONESBORO, AR 72401-5828
(870) 932-0090
(870) 930-9336
Mailing address
321 DUNWOODY DR, JONESBORO, AR 72404-8889
(870) 930-6372
(870) 930-9336
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
10127-C
AR
104100000X
Social Worker
10127-M
AR
235Z00000X
Speech-Language Pathologist
SP#1761
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142215721
—
AR
01
—
SP 5W442
BCBS
AR
Enumeration date
11/09/2006
Last updated
02/01/2023
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