Provider Demographics
NPI:1730345588
Name:PORTER, HEATHER LYNN KINKADE (LCSW)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:LYNN KINKADE
Last Name:PORTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:KINKADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:BENA
Mailing Address - State:VA
Mailing Address - Zip Code:23018-0007
Mailing Address - Country:US
Mailing Address - Phone:804-815-3166
Mailing Address - Fax:
Practice Address - Street 1:515 STERNBERG AVE
Practice Address - Street 2:USAMEDDAC, FAMILY ADVOCACY PROGRAM
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-1526
Practice Address - Country:US
Practice Address - Phone:757-314-7966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040061681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical