Mark Thomas Potaracke, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C019093 Issued in NC

Practice address

209 Timberlake Dr
Fayetteville, NC 28314-1241

Phone

(608) 451-5622

NPI assigned

Nov 5, 2025

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 5, 2025.

{
    "created_epoch": "1762300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762300800000",
    "number": "1003785122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 TIMBERLAKE DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283141241",
            "telephone_number": "608-451-5622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 TIMBERLAKE DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283141241",
            "telephone_number": "608-451-5622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTARACKE",
        "first_name": "MARK",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-11-05",
        "last_updated": "2025-11-05",
        "certification_date": "2025-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C019093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Positive Reinforcement
• Courtney E Post Keefer, AUD
• Kenyatta Trenae Postage, BCBA
• Angela Poston, RRT
• Vickie Lynn Poston, NNP
• Robert Richard Potelunas
• Amanda Elizabeth Potter
• Phyllis Ann Potter, MS, LPC, NCC, RPT
• Potter'S House Outreach Corporation
• Potter'S House Outreach Corporation

• All providers in Fayetteville, NC
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.