Basic Information
| Provider Information | |||||||||
| NPI: | 1689625444 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POTTER | ||||||||
| FirstName: | DARILOU | ||||||||
| MiddleName: | DEE | ||||||||
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| Credential: | NCC-BC LPC LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4743 FIR DELL DR SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973024812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033326134 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1675 WINTER ST NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035850351 | ||||||||
| FaxNumber: | 5035850212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LH00006910 | WA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | C1643 | OR | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.