Provider Demographics
NPI:1639198153
Name:RAWLES, PORTIA DENEEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PORTIA
Middle Name:DENEEN
Last Name:RAWLES
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 1:2010 OLD GREENBRIER RD STE G
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2619
Mailing Address - Country:US
Mailing Address - Phone:757-493-2912
Mailing Address - Fax:866-730-6583
Practice Address - Street 1:2010 OLD GREENBRIER RD STE G
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2619
Practice Address - Country:US
Practice Address - Phone:757-493-2912
Practice Address - Fax:866-730-6583
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3884103TC0700X
VA0810003069103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VASC0001033OtherMEDICARE
VA010177669Medicaid
VA2248507OtherCIGNA
VA450517829OtherTRI CARE NORTH
VA7277741OtherAETNA
VA180317OtherANTHEM
VA1639198153OtherVIRGINIA PREMIER
NC6001245Medicaid
VA085601MOtherOPTIMA