Provider Demographics
NPI:1295915965
Name:TURNER PORTER, LISA NADINE (LPCMH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:NADINE
Last Name:TURNER PORTER
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CHAPMAN RD STE 203E
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5491
Mailing Address - Country:US
Mailing Address - Phone:302-525-6521
Mailing Address - Fax:302-533-5537
Practice Address - Street 1:260 CHAPMAN RD STE 203E
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5491
Practice Address - Country:US
Practice Address - Phone:302-525-6521
Practice Address - Fax:302-533-5537
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000425101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250503009Medicaid