Provider Demographics
NPI:1609042100
Name:PORTER, SYLVIA JOYCE (MA, NCC, LCPC)
Entity Type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:JOYCE
Last Name:PORTER
Suffix:
Gender:F
Credentials:MA, NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5928
Mailing Address - Country:US
Mailing Address - Phone:309-682-6258
Mailing Address - Fax:309-682-6472
Practice Address - Street 1:4806 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5928
Practice Address - Country:US
Practice Address - Phone:309-682-6258
Practice Address - Fax:309-682-6472
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006561101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health