🏥

Active NPI 1710173802 Organization (Entity Type 2)

Potentials, Llc

Community/Behavioral Health • Astoria, OR

About Potentials, Llc NPI 1710173802 Summary

Potentials, Llc is a verified healthcare organization specializing in Community/Behavioral Health operating in Astoria, OR. Located at 100 39TH ST PIER 39, this facility provides patient care and medical services under National Provider Identifier (NPI) 1710173802.

Administrative operations and authorized compliance are overseen by Dana Dedolph (Director/Therapist).

Facility Location & Contact Primary Location

Facility Address

100 39th St Pier 39

Astoria, OR 971032499

Telephone 5033252398

Fax 5033255932

Authorized Official Information

Authorized Contact Name

MS. Dana Dedolph , MA, LPC

Title / Role

Director/therapist

Official Telephone

5033252398

Facility Classifications & Specialties

Community/Behavioral Health Primary Taxonomy

NUCC Taxonomy Code: 251S00000X

A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events

✅

NPI Profile Active September 21, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location September 21, 2007

Registered at 100 39TH ST PIER 39, ASTORIA, OR 971032499 (Tel: 5033252398)

📍

Updated Business Mailing Address September 21, 2007

Registered at 100 39TH ST PIER 39, ASTORIA, OR 971032499 (Tel: 5033252398)

🏛️

Organization / Clinic Name Updated September 21, 2007

Operating as POTENTIALS, LLC

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) September 21, 2007

Community/Behavioral Health (License #C1489 in OR)

🟢

Initial NPI Registration & Enumeration September 21, 2007

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

Verified patient ratings, healthcare experiences, and facility photos

0 Reviews

No reviews submitted yet for Potentials, Llc. Be the first to share your experience with this healthcare facility!

Have you visited Potentials, Llc? Sign in to your TRUE-MEDINFO account to submit a rating and review.

NPI Organization Metadata

NPI Number: 1710173802

Entity Type:

Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)

Enumeration Date: September 21, 2007

Last Update: September 21, 2007

Update or Correct Listing

Mailing Address

100 39th St Pier 39

Astoria, OR 971032499

Phone: 5033252398

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.

⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.