1730138132 NPI number — MRS. PATRICE PORTER NCC LPC LSATP

Table of content: MRS. PATRICE PORTER NCC LPC LSATP (NPI 1730138132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730138132 NPI number — MRS. PATRICE PORTER NCC LPC LSATP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTER
Provider First Name:
PATRICE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NCC LPC LSATP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730138132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 SHENANDOAH VILLAGE DRIVE
Provider Second Line Business Mailing Address:
SUITE 124
Provider Business Mailing Address City Name:
WAYNESBORO
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-932-7800
Provider Business Mailing Address Fax Number:
540-932-7191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 SHENANDOAH VILLAGE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 124
Provider Business Practice Location Address City Name:
WAYNESBORO
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-932-7800
Provider Business Practice Location Address Fax Number:
540-932-7191
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701002329 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 344339 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5413524 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 083331 . This is a "SENTARA MENTAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202410 . This is a "COMPSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5413524 . This is a "VIRGINIA PREMIER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 141497 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 508398 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".




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