Individual
ANTONIA JO LYNN PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASTER OF SCIENCE
Contact information
Practice address
546 VIRGINIA AVE, BLUEFIELD, VA 24605-1729
(305) 432-1672
Mailing address
546 VIRGINIA AVE, BLUEFIELD, VA 24605-1729
(305) 432-1672
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701010316
VA
101YP2500X
Professional Counselor
2032
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005489001
—
WV
05
—
0005489002
—
WV
Enumeration date
08/29/2012
Last updated
08/20/2021
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