Provider Demographics
NPI:1518143387
Name:BURNS-PORTER, ANNETTE YVONNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:YVONNE
Last Name:BURNS-PORTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 KAYHILL LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2705
Mailing Address - Country:US
Mailing Address - Phone:301-441-1986
Mailing Address - Fax:
Practice Address - Street 1:819 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4197
Practice Address - Country:US
Practice Address - Phone:410-431-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty