Individual
MARISSA PORTEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
153 RIVULET DR, DALLAS, GA 30132-9322
(770) 342-9691
Mailing address
153 RIVULET DR, DALLAS, GA 30132-9322
(770) 342-9691
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC010134
GA
Other
Enumeration date
08/29/2023
Last updated
08/29/2023
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