Provider Demographics
NPI:1477855690
Name:MARK PORTER ED D CAP
Entity Type:Organization
Organization Name:MARK PORTER ED D CAP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, CAP
Authorized Official - Phone:941-955-5454
Mailing Address - Street 1:240 N WASHINGTON BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5945
Mailing Address - Country:US
Mailing Address - Phone:941-955-5454
Mailing Address - Fax:
Practice Address - Street 1:240 N WASHINGTON BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5945
Practice Address - Country:US
Practice Address - Phone:941-955-5454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4711251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health