Healthcare Provider Details

I. General information

NPI: 1861462780
Provider Name (Legal Business Name): NATALIE ANN PORTER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 MOHEGAN AVE
NEW LONDON CT
06320-4125
US

IV. Provider business mailing address

270 MOHEGAN AVE
NEW LONDON CT
06320-4125
US

V. Phone/Fax

Practice location:
  • Phone: 860-439-4587
  • Fax: 860-439-4587
Mailing address:
  • Phone: 860-439-4587
  • Fax: 860-439-2317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0086471
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002066
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: