Provider Demographics
NPI:1003322652
Name:PORTILLO, ERIKA LANETTE (MED, LMHP-R)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:LANETTE
Last Name:PORTILLO
Suffix:
Gender:F
Credentials:MED, LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3541 CHAIN BRIDGE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2793
Mailing Address - Country:US
Mailing Address - Phone:703-218-6599
Mailing Address - Fax:703-218-2012
Practice Address - Street 1:3541 CHAIN BRIDGE RD STE 204
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2793
Practice Address - Country:US
Practice Address - Phone:703-218-6599
Practice Address - Fax:703-218-2012
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health