MEDICARE: DR. HELOISA H PORTELA LPC NCC

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	101YP2500X	Professional Counselor	LPC 4935	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	14176	OTHER	NC	BCBSNC PROVIDER NUMBER

General Provider Information

NPI Number	:	1578574166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HELOISA H PORTELA LPC NCC

Provider Business Mailing Address
First Line	:	8416 PARKSTONE DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-6888
Country	:	US
Telephone Number	:	919-368-5207
Fax Number	:	919-882-9505

Provider Business Practice Location Address
First Line	:	8400 SIX FORKS RD
Second Line	:	SUITE 203
City	:	RALEIGH
State	:	NC
Zip	:	27615-3068
Country	:	US
Telephone Number	:	919-368-5207
Fax Number	:	919-882-9505

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	01/08/2009

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