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General NPI Number Information
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NPI Number | 1659442093
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Entity Type | Individual
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Provider Name | NICOLE RENAE POTTS LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 151 SOUTHWEST DR
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City | JONESBORO
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State | AR
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Zip | 72401-5828
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Country | US
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Telephone | 870-932-0090
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Fax | 870-930-9336
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Provider Business Mailing Address
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Address Line | 321 DUNWOODY DR
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City | JONESBORO
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State | AR
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Zip | 72404-8889
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Country | US
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Telephone | 870-930-6372
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Fax | 870-930-9336
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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 | 10127-M
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP#1761
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 10127-C
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License Number State | AR
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