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General NPI Number Information
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NPI Number | 1568049674
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Entity Type | Individual
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Provider Name | MS. EBONIE DANIELLE POTTER
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Gender | Female
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 1301 CAROLINA ST
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City | GREENSBORO
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State | NC
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Zip | 27401-1032
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Country | US
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Telephone | 336-542-2060
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Fax |
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Provider Business Mailing Address
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Address Line | 4910 KOGER BLVD APT 3H
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City | GREENSBORO
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State | NC
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Zip | 27407-2794
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Country | US
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Telephone | 336-254-6618
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A16402
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License Number State | NC
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