Provider Demographics
NPI:1942376470
Name:PORTER, MARCIA WILLIAMS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:WILLIAMS
Last Name:PORTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1323 AVIATION BLVD
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4010
Mailing Address - Country:US
Mailing Address - Phone:310-966-6591
Mailing Address - Fax:310-231-0760
Practice Address - Street 1:11080 W OLYMPIC BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1937
Practice Address - Country:US
Practice Address - Phone:310-966-6591
Practice Address - Fax:310-231-0760
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA233311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical