Individual
LISA G PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
645 INTERSTATE DR, GRAYSON, KY 41143-1704
(606) 474-0669
Mailing address
2901 PIGEON ROOST RD, RUSH, KY 41168-8132
(606) 928-6648
(606) 928-1056
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
252292
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100835480
—
KY
Enumeration date
10/13/2011
Last updated
09/14/2023
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