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Individual

MS. ELIZABETH PORTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
4109 W JEFFERSON BLVD, STE A, FORT WAYNE, IN 46804-8694
(260) 486-5251
(260) 486-5058
Mailing address
4109 W JEFFERSON BLVD, STE A, FORT WAYNE, IN 46804-8694
(260) 486-5251
(260) 486-5058

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
33006395A
IN
1041C0700X
Clinical Social Worker
Primary
34007078A
IN

Other

Enumeration date
01/31/2013
Last updated
04/03/2024
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