Healthcare Provider Details

I. General information

NPI: 1851669238
Provider Name (Legal Business Name): MR. JOSHUA POTTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 SUMMER ST
PHILADELPHIA PA
19107-1633
US

IV. Provider business mailing address

322 W SPENCER ST
PHILADELPHIA PA
19120-1819
US

V. Phone/Fax

Practice location:
  • Phone: 215-772-0101
  • Fax:
Mailing address:
  • Phone: 267-974-1993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: