Provider Demographics
NPI:1619791167
Name:PORCH, CHARLES STEPHEN (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:STEPHEN
Last Name:PORCH
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 BELLO VEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-9391
Mailing Address - Country:US
Mailing Address - Phone:304-242-6250
Mailing Address - Fax:
Practice Address - Street 1:175 BELLO VEDERE AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-9391
Practice Address - Country:US
Practice Address - Phone:304-242-6250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001077101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional