Healthcare Provider Details

I. General information

NPI: 1598718777
Provider Name (Legal Business Name): WILLIAM HOLLIS POTTER LPC, LCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E COURT ST
MARION NC
28752-1864
US

IV. Provider business mailing address

2187 OAKDALE RD
OLD FORT NC
28762-8836
US

V. Phone/Fax

Practice location:
  • Phone: 828-659-8626
  • Fax: 828-659-6383
Mailing address:
  • Phone: 828-668-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number551
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4731
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: