Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 16680 | MA |
NPI | 1003428897 |
---|---|
Provider Name | Francesca Nicole Porter |
First Address | Enfield, CT 06082-6144 |
Second Address | Enfield, CT 06082-6144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2020 |
Last Update Date | 21/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16680 | (05) | MA |