Provider Demographics
NPI:1447653019
Name:SEVEN COUNTIES
Entity type:Organization
Organization Name:SEVEN COUNTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANIQUA
Authorized Official - Middle Name:L
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-419-5466
Mailing Address - Street 1:8202 VERMISSA CT
Mailing Address - Street 2:APT. 4
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3790
Mailing Address - Country:US
Mailing Address - Phone:502-419-5466
Mailing Address - Fax:
Practice Address - Street 1:8202 VERMISSA CT
Practice Address - Street 2:APT. 4
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3790
Practice Address - Country:US
Practice Address - Phone:502-419-5466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty