Provider Demographics
NPI:1598323164
Name:PORTER, KELLEY (LCPC)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:ENSKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9649 BELAIR RD STE 104
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1117
Mailing Address - Country:US
Mailing Address - Phone:410-529-1309
Mailing Address - Fax:410-529-1005
Practice Address - Street 1:9649 BELAIR RD STE 104
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-1117
Practice Address - Country:US
Practice Address - Phone:410-529-1309
Practice Address - Fax:410-529-1005
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9575101YP2500X
MDLC11431101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional