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General NPI Number Information
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NPI Number | 1851840292
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Entity Type | Individual
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Provider Name | EDGINA PORTER LICSW, LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 01/06/2023
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Provider Practice Location Address
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Address Line | 10206 AEROSPACE RD
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City | LANHAM
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State | MD
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Zip | 20706
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Country | US
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Telephone | 301-760-8615
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Fax |
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Provider Business Mailing Address
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Address Line | 20000 SWEETGUM CIR APT 12
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City | GERMANTOWN
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State | MD
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Zip | 20874-3756
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Country | US
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Telephone | 301-760-8615
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50080928
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License Number State | DC
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