Individual
MS. TARA BURTON PORTEE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
222 N MAIN ST, SUITE 320, HOPEWELL, VA 23860-2712
(804) 541-6708
Mailing address
222 N MAIN ST, SUITE 320, HOPEWELL, VA 23860-2712
(804) 541-6708
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0904003636
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4945280
—
VA
Enumeration date
06/16/2006
Last updated
07/08/2007
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