Provider Demographics
NPI:1730138132
Name:PORTER, PATRICE (NCC LPC LSATP)
Entity type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:NCC LPC LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SHENANDOAH VILLAGE DRIVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980
Mailing Address - Country:US
Mailing Address - Phone:540-932-7800
Mailing Address - Fax:540-932-7191
Practice Address - Street 1:920 SHENANDOAH VILLAGE DRIVE
Practice Address - Street 2:SUITE 124
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980
Practice Address - Country:US
Practice Address - Phone:540-932-7800
Practice Address - Fax:540-932-7191
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002329101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
344339OtherMHN
VA5413524Medicaid
083331OtherSENTARA MENTAL HEALTH
202410OtherCOMPSYCH
5413524OtherVIRGINIA PREMIER
141497OtherANTHEM
508398OtherVALUE OPTIONS