Provider Demographics
NPI:1396480943
Name:PORTER, BETH STARR (LMBT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:STARR
Last Name:PORTER
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 FOXFIRE DR APT A
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3189
Mailing Address - Country:US
Mailing Address - Phone:910-746-7385
Mailing Address - Fax:
Practice Address - Street 1:56 FOXFIRE DR APT A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3189
Practice Address - Country:US
Practice Address - Phone:910-746-7385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18466225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0777OtherHAWK RIDGE