Basic Information
| Provider Information | |||||||||
| NPI: | 1053640664 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE POTTER'S HOUSE FAMILY COUNSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 312 E 1ST AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296403064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648501777 | ||||||||
| FaxNumber: | 8648501777 | ||||||||
| Practice Location | |||||||||
| Address1: | 312 E 1ST AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296403064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648501777 | ||||||||
| FaxNumber: | 8648501777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2009 | ||||||||
| LastUpdateDate: | 12/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | SHORTER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8648501777 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | REV | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP1600X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Pastoral |
No ID Information.