Individual
DAVE POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.P.C.
Contact information
Practice address
814 S WASHINGTON ST, MOSCOW, ID 83843-3049
(208) 883-0619
Mailing address
1009 TOLO TRL, MOSCOW, ID 83843-8767
(208) 882-6834
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-3724
ID
Other
Enumeration date
08/11/2005
Last updated
07/08/2007
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