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General NPI Number Information
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NPI Number | 1417409723
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Entity Type | Individual
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Provider Name | DAVID POTTS LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 45991 BERMONT RD
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City | PUNTA GORDA
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State | FL
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Zip | 33982-9653
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Country | US
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Telephone | 941-575-5790
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Fax |
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Provider Business Mailing Address
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Address Line | 27409 SUNSET DR
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City | PUNTA GORDA
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State | FL
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Zip | 33955-2327
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Country | US
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Telephone | 941-875-0324
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW 13643
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License Number State | FL
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