Provider Demographics
NPI:1265861140
Name:PORTER, AMEIKA (RASI)
Entity Type:Individual
Prefix:
First Name:AMEIKA
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:RASI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 W 82ND ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-2813
Mailing Address - Country:US
Mailing Address - Phone:323-470-1204
Mailing Address - Fax:310-217-0545
Practice Address - Street 1:1529 WEST 82ND STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047
Practice Address - Country:US
Practice Address - Phone:323-470-1204
Practice Address - Fax:310-217-0545
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor