Healthcare Provider Details

I. General information

NPI: 1417657255
Provider Name (Legal Business Name): CAROLIE DIONNE POTEAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE
WASHINGTON DC
20002-1848
US

IV. Provider business mailing address

1208 ACCOKEEK LANDING DR
ACCOKEEK MD
20607-2271
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-2401
  • Fax:
Mailing address:
  • Phone: 301-792-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: