Provider Demographics
NPI:1750504452
Name:NEWBOLD, PORTIA J (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:PORTIA
Middle Name:J
Last Name:NEWBOLD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14725 NE 5TH COURT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161
Mailing Address - Country:US
Mailing Address - Phone:305-948-2369
Mailing Address - Fax:305-948-2369
Practice Address - Street 1:1469 NW 36 STREET
Practice Address - Street 2:NEW HORIZONS COMMUNITY MENTAL HEALTH CENTER INC
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142
Practice Address - Country:US
Practice Address - Phone:305-635-7444
Practice Address - Fax:305-635-6378
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health