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General NPI Number Information
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NPI Number | 1568022770
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Entity Type | Individual
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Provider Name | TRACEY POTTER LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 111 W HIGH ST STE 204
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City | ELKTON
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State | MD
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Zip | 21921-8611
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Country | US
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Telephone | 410-620-0008
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7356
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City | LANCASTER
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State | PA
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Zip | 17604-7356
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 21214
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License Number State | MD
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