Phyllis Ann Potter, MS, LPC, NCC, RPT
Individual provider Active NPI Mental Health Counselor · Fayetteville, NC
NPI 1508294166 · NPPES record last updated Jun 30, 2016
Key facts
- NPI
- 1508294166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 10432 (NC)
- Practice address
- 930 Cambridge St
Suite 109
Fayetteville, NC 28303-9625 - Phone
- (910) 484-2202
- Fax
- (910) 484-2203
- NPI assigned
- Oct 17, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241210004038 | NC | Practitioner - Mental Health Counselor | 8527594837 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10432 | NC | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Caring Hearts Professional Counseling Services, PLLC | Mental Health | Current |
Accepting new patients |
Locations
312 College St
Ste C
Clinton, NC 28328
Phone (910) 299-0848
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 10432 | NC | Yes |
Addresses
Primary practice location
930 Cambridge St
Suite 109
Fayetteville, NC 28303-9625
Mailing address
PO Box 1734
Clinton, NC 28329-1734
Phone (910) 299-0848
Other providers in Fayetteville, NC
- Angela Poston
- Vickie Lynn Poston
- Mark Thomas Potaracke
- Robert Richard Potelunas
- Amanda Elizabeth Potter
- Potter'S House Outreach Corporation
- Potter'S House Outreach Corporation
- Frederick Potts Sr.
- Asmita Poudel
- Deanna Poulk
All providers in Fayetteville, NC · Mental Health Counselor in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.