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General NPI Number Information
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NPI Number | 1689798779
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Entity Type | Individual
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Provider Name | BETHANY PORTER LCPC, LPC, LMHC
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Gender | Female
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 6720 PATTERSON AVE STE C
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City | RICHMOND
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State | VA
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Zip | 23226-3434
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Country | US
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Telephone | 301-537-8846
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Fax |
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Provider Business Mailing Address
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Address Line | 8616 CHOCTAW RD
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-2428
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Country | US
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Telephone | 301-537-8846
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 093646
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC2095
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701005093
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License Number State | VA
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