Provider Demographics
NPI:1083058051
Name:KRISTEN PORTER, LPC, PLLC
Entity Type:Organization
Organization Name:KRISTEN PORTER, LPC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:MARLEAU
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:919-376-5330
Mailing Address - Street 1:2100 TURTLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-8469
Mailing Address - Country:US
Mailing Address - Phone:919-376-5330
Mailing Address - Fax:919-400-4821
Practice Address - Street 1:992 DURHAM RD
Practice Address - Street 2:SUITE A
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6589
Practice Address - Country:US
Practice Address - Phone:919-376-5330
Practice Address - Fax:919-400-4821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty