Individual
SHANIQUA POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
708 MAGAZINE ST, LOUISVILLE, KY 40203-2043
(502) 589-8926
(502) 585-4218
Mailing address
101 W MUHAMMAD ALI BLVD, LOUISVILLE, KY 40202-1423
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/12/2007
Last updated
12/09/2014
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