Healthcare Provider Details

I. General information

NPI: 1568092575
Provider Name (Legal Business Name): DONISHA D PORTER LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 YORK RD STE 201
BALTIMORE MD
21212-3620
US

IV. Provider business mailing address

606 RILEY CT APT E
JOPPA MD
21085-4678
US

V. Phone/Fax

Practice location:
  • Phone: 410-939-8744
  • Fax:
Mailing address:
  • Phone: 667-289-4168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25225
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: