Provider Demographics
NPI:1891942017
Name:PORTER, KRISTEN MARLEAU (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MARLEAU
Last Name:PORTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 TURTLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-8469
Mailing Address - Country:US
Mailing Address - Phone:919-376-5330
Mailing Address - Fax:
Practice Address - Street 1:2100 TURTLE POINT DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-8469
Practice Address - Country:US
Practice Address - Phone:919-376-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7018101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103969Medicaid