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Organization
THE PORTLOCK GROUP, PLLC
Active
Organization
THE PORTLOCK GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPFON TEONTA PORTLOCK LCSW (CLINICAL DIRECTOR)
(704) 780-9628
Entity
Organization
Contact information
Practice address
4935 ALBEMARLE RD, CHARLOTTE, NC 28205-6617
(704) 780-9628
(704) 566-9038
Mailing address
PO BOX 505, NEWELL, NC 28126-0505
(704) 780-9628
(704) 566-9038
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C008189
NC
Other
Enumeration date
03/31/2014
Last updated
03/31/2014
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