Provider Demographics
NPI:1255916151
Name:PORTER, LAKEITHEA ANNE
Entity type:Individual
Prefix:
First Name:LAKEITHEA
Middle Name:ANNE
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66950 IRONWOOD DR APT E231
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-4405
Mailing Address - Country:US
Mailing Address - Phone:760-605-5495
Mailing Address - Fax:
Practice Address - Street 1:66950 IRONWOOD DR APT E231
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-4405
Practice Address - Country:US
Practice Address - Phone:760-605-5495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor