Organization Name: | KRISTEN PORTER, LPC, PLLC |
NPI Number: | 1083058051 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KRISTEN MARLEAU PORTER (SOLE MEMBER) |
Mailing Address: | 992 Durham Rd Suite A Wake Forest |
State: | NC US |
Postal Code: | 275876589 |
Phone Number: | 9193765330 |
Fax Number: | 9194004821 |
NPI Enumeration Date: | 04/22/2013 |
NPI Last Update Date: | 04/22/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 7018 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |