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General NPI Number Information
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NPI Number | 1699215970
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Entity Type | Organization
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Legal Business Name | DAVID M PORTNER, PH.D. PLC
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 1428 WATER MILL CIR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-1359
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Country | US
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Telephone | 757-642-2567
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Fax | 757-233-0201
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Provider Business Mailing Address
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Address Line | 1428 WATER MILL CIR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-1359
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Country | US
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Telephone | 757-642-2567
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Fax | 757-233-0201
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID MICHAEL PORTNER
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Credential | PH.D.
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Telephone | 757-642-2567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810001188
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License Number State | VA
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