Provider Demographics
NPI:1538523824
Name:PORTER, JUSTYNA K (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JUSTYNA
Middle Name:K
Last Name:PORTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 7490, SOUTHERLAND CIRCLE AND PROVIDE COMFORT RD
Mailing Address - Street 2:ROBINSON FAMILY MEDICINE CLINIC
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-8239
Mailing Address - Country:US
Mailing Address - Phone:910-476-2931
Mailing Address - Fax:
Practice Address - Street 1:BLDG 7490, SOUTHERLAND CIRCLE AND PROVIDE COMFORT RD
Practice Address - Street 2:ROBINSON FAMILY MEDICINE CLINIC
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-8239
Practice Address - Country:US
Practice Address - Phone:910-476-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC0099741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical