Healthcare Provider Details

I. General information

NPI: 1811240294
Provider Name (Legal Business Name): ANGELA MONIQUE PORTER M.A., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 MONTGOMERY BLVD NE APT 207
ALBUQUERQUE NM
87109-1085
US

IV. Provider business mailing address

3901 MONTGOMERY BLVD NE APT 207
ALBUQUERQUE NM
87109-1085
US

V. Phone/Fax

Practice location:
  • Phone: 505-410-9538
  • Fax:
Mailing address:
  • Phone: 505-410-9538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0167911
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: