| Potentials, Llc | |
|
100 39th St Pier 39 Astoria OR 97103-2499 | |
| (503) 325-2398 | |
| (503) 325-5932 |
| Full Name | Potentials, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 100 39th St Pier 39, Astoria, Oregon |
| Authorized Official Name and Position | Dana S Dedolph (DIRECTOR/THERAPIST) |
| Authorized Official Contact | 5033252398 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Potentials, Llc 100 39th St Pier 39 Astoria OR 97103-2499 Ph: (503) 325-2398 | Potentials, Llc 100 39th St Pier 39 Astoria OR 97103-2499 Ph: (503) 325-2398 |
| NPI Number | 1710173802 |
|---|---|
| Provider Enumeration Date | 09/21/2007 |
| Last Update Date | 09/21/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710173802 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | C1489 (Oregon) | Primary |
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