Individual
CHRISTINA PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
8647 W LILLYWOOD ST, BOISE, ID 83709-7922
(208) 703-2212
Mailing address
8647 W LILLYWOOD ST, BOISE, ID 83709-7922
(208) 703-2212
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-33923
ID
1041C0700X
Clinical Social Worker
LCSW-41170
ID
Other
Enumeration date
08/12/2014
Last updated
08/12/2022
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