| NPI | 1073001954 |
|---|---|
| Former Name | STEPHANIE ANN PORTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.171914) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2021-01-25 |