Provider Demographics
NPI:1518487040
Name:PORTERA, TABITHA (LCPC)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:PORTERA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5514
Mailing Address - Country:US
Mailing Address - Phone:207-944-6766
Mailing Address - Fax:
Practice Address - Street 1:20 E SUMMER ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5514
Practice Address - Country:US
Practice Address - Phone:207-944-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL482101YP2500X
MECC5728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional