Healthcare Provider Details

I. General information

NPI: 1609502368
Provider Name (Legal Business Name): KRISTIN NOEL POTTS CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E. CRESCENTVILLE ROAD
CINCINNATI OH
45246-1302
US

IV. Provider business mailing address

8444 N 90TH ST STE 100
SCOTTSDALE AZ
85258-4437
US

V. Phone/Fax

Practice location:
  • Phone: 513-671-7117
  • Fax: 513-671-7110
Mailing address:
  • Phone: 602-248-8886
  • Fax: 480-687-7361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.181194
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: