MEDICARE: MS. CHRISTINA NICOLE PORTER LCDC II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	162156	OH

General Provider Information

NPI Number	:	1306665005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINA NICOLE PORTER LCDC II

Provider Business Mailing Address
First Line	:	608 W MADISON ST
Second Line	:
City	:	NEW CARLISLE
State	:	OH
Zip	:	45344-1626
Country	:	US
Telephone Number	:	937-620-9907
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 W 1ST ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-3033
Country	:	US
Telephone Number	:	513-228-6590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	05/11/2026

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