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General NPI Number Information
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NPI Number | 1457718900
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Entity Type | Individual
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Provider Name | MRS. LISA MARIE PORTER
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Gender | Female
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 225 N MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60601
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Country | US
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Telephone | 407-501-2994
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 ALICE DR APT 68
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City | SUMTER
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State | SC
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Zip | 29150-1604
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH17564
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License Number State | FL
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