Individual
ANTOINETTE L PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1258 HOLLAND RD, SUFFOLK, VA 23434-6313
(757) 409-4771
Mailing address
4009 MICHAEL DR, SUFFOLK, VA 23432-1436
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0710103646
VA
Other
Enumeration date
11/24/2021
Last updated
11/24/2021
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