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Organization

PORTIS MARRIAGE AND CHILDREN COUNSELING CLINIC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ALICE FAYE PORTIS-PATTERSON MSW, LPC (CLINICAL DIRECTOR/THERAPIST)
(262) 884-9734
Entity
Organization

Contact information

Practice address
5801 WASHINGTON AVE STE 103, RACINE, WI 53406-4057
(262) 884-9734
(262) 884-9735
Mailing address
5801 WASHINGTON AVE STE 110, RACINE, WI 53406-4057
(262) 884-9734
(262) 884-9735

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
947-125
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
39228200
WI
Enumeration date
03/05/2008
Last updated
02/15/2011
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