Margie Ethel Potter, CICA00860419

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CICA00860419 Issued in CA

Practice address

10877 Conductor Blvd Ste 300
Sutter Creek, CA 95685-9688

Phone

(209) 223-6412

NPI assigned

Apr 1, 2015

Last updated

Oct 19, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• County of Amador

  • Community/Behavioral Health Agency
  • Sutter Creek, CA
  • NPI 1205055886
  NPD (past)
• County of Amador

  dba Amador County Behavioral Health SUD

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Sutter Creek, CA
  • NPI 1699321752
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666137600000",
    "number": "1639564149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10877 CONDUCTOR BLVD STE 300",
            "city": "SUTTER CREEK",
            "state": "CA",
            "postal_code": "956859688",
            "telephone_number": "209-223-6412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10877 CONDUCTOR BLVD STE 300",
            "city": "SUTTER CREEK",
            "state": "CA",
            "postal_code": "956859688",
            "telephone_number": "209-223-6412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTER",
        "first_name": "MARGIE",
        "middle_name": "ETHEL",
        "name_prefix": "Mrs.",
        "credential": "CICA00860419",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-01",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "CICA00860419",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee Michelle Paul
• Jessica Michelle Pelton, AMFT
• Madalen Petersen, SUDRA
• Leona Kay Phillips, LMFT,M.A.,PHD
• Todd Randall Pickens, O.D.
• Klaudia Promessi
• Brittany Purdy Angeja, M.S.
• Liesl Corrin Renfree
• Roxana Rhodes, LMFT#112120
• Toni Russell

• Addiction (Substance Use Disorder) Counselor in Sutter Creek, CA
• Providers in Sutter Creek, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; 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.