Doctor Name: | ANTONIA JO LYNN PORTER |
NPI Number: | 1730437336 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MASTER OF SCIENCE |
License Number: | 2032 |
Business Practice Address: | 151 Us Route 52 N Welch, WV - 248012553 |
Business Phone Number: | 3044362106 |
Business Fax Number: | 3044366362 |
Mailing Address: | 200 12th Street Ext, PRINCETON |
State: | WV |
Postal Code: | 247402329 |
Phone Number: | 3044259541 |
Fax Number: | 3044876199 |
NPI Enumeration Date: | 08/29/2012 |
NPI Last Update Date: | 08/29/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 2032 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |