Healthcare Provider Details

I. General information

NPI: 1982275517
Provider Name (Legal Business Name): JOEL EMMANUEL PORTER LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 LITTLE PATUXENT PKWY STE 209
COLUMBIA MD
21044-6278
US

IV. Provider business mailing address

11720 BELTSVILLE DR STE 500
BELTSVILLE MD
20705-3139
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-8066
  • Fax: 410-740-8068
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC11638
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLC11638
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC11638
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: