Provider Demographics
NPI:1114935186
Name:FROST-PORTERFIELD, GINA MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:FROST-PORTERFIELD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:FROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:12850 FOUNTAIN SQ
Mailing Address - Street 2:STE. 106
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-2552
Mailing Address - Country:US
Mailing Address - Phone:248-634-6303
Mailing Address - Fax:248-634-1746
Practice Address - Street 1:12850 FOUNTAIN SQ
Practice Address - Street 2:STE. 106
Practice Address - City:DAVISBURG
Practice Address - State:MI
Practice Address - Zip Code:48350-2552
Practice Address - Country:US
Practice Address - Phone:248-634-6303
Practice Address - Fax:248-634-1746
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005624101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional