Potentials, LLC
Community/Behavioral Health in Astoria, OR. Organization (NPI-2).
NPI number1710173802
StatusActive
Last updated in NPPESSep 21, 2007
Details
- NPI
- 1710173802
- Entity type
- Organization (NPI-2)
- Legal business name
- Potentials, LLC
- Organization subpart
- No
- Enumeration date
- Sep 21, 2007
- Last updated
- Sep 21, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | C1489 | OR | Yes |
Practice location
100 39th St Pier 39Astoria, OR 97103-2499
Phone 503-325-2398 · Fax 503-325-5932
Mailing address
100 39th St Pier 39Astoria, OR 97103-2499
Phone 503-325-2398 · Fax 503-325-5932
Authorized official
Dana S Dedolph
Director/Therapist
5033252398
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