Provider Demographics
NPI:1861462780
Name:PORTER, NATALIE ANN (LPCC)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:ANN
Last Name:PORTER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 MOHEGAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4125
Mailing Address - Country:US
Mailing Address - Phone:860-439-4587
Mailing Address - Fax:860-439-2317
Practice Address - Street 1:270 MOHEGAN AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4125
Practice Address - Country:US
Practice Address - Phone:860-439-4587
Practice Address - Fax:860-439-4587
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0086471101YM0800X
CT002066101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health