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1063077378
KAITLYNN M PORTILLO
JACKSONVILLE, NC
NPI
1063077378
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Additional Taxonomies
101YM0800X Counselor, Mental Health
Enumeration Date
2019-05-02
Last Update Date
2021-02-17
Business Address
KAITLYNN M PORTILLO
200 DOCTORS DR STE 200
JACKSONVILLE, NC 28546-6310
Phone number: 910-333-0814
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Mailing Address
KAITLYNN M PORTILLO
41 PACELLA PARK DR
RANDOLPH, MA 02368-1755
Phone number: 910-333-0814
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