Individual
MR. KYLE PERRY POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
110 ELMWOOD AVE, PROVIDENCE, RI 02907-2423
(401) 300-5757
(401) 300-5656
Mailing address
104 RIVER ST, WAKEFIELD, RI 02879-3212
(401) 499-8286
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
06/25/2019
Last updated
06/25/2019
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