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General NPI Number Information
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NPI Number | 1609589035
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Entity Type | Individual
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Provider Name | MILLER POTOMA LPC
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Gender | Male
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Dates
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Enumeration Date | 12/30/2022
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 502 W 7TH ST STE 100
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City | ERIE
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State | PA
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Zip | 16502-1333
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Country | US
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Telephone | 215-645-2537
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Fax | 267-223-7061
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Provider Business Mailing Address
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Address Line | 609 S 55TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19143-2503
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Country | US
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Telephone | 215-645-2537
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Fax | 267-223-7061
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC019444
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License Number State | PA
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