Healthcare Provider Details

I. General information

NPI: 1841489853
Provider Name (Legal Business Name): KIMBERLY ANN PORTER MA, LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 ELSINORE PL STE 500
CINCINNATI OH
45202-1455
US

IV. Provider business mailing address

615 ELSINORE PL STE 500
CINCINNATI OH
45202-1455
US

V. Phone/Fax

Practice location:
  • Phone: 859-231-6630
  • Fax:
Mailing address:
  • Phone: 513-231-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE-0600692
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: