Provider Demographics
NPI:1285283069
Name:PORTER, ERICA JANE (LPC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:JANE
Last Name:PORTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:JANE
Other - Last Name:RYBAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2735 N HOLLAND SYLVANIA RD STE A1
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1844
Mailing Address - Country:US
Mailing Address - Phone:419-315-6422
Mailing Address - Fax:833-381-0977
Practice Address - Street 1:2735 N HOLLAND SYLVANIA RD STE A1
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1844
Practice Address - Country:US
Practice Address - Phone:419-315-6422
Practice Address - Fax:833-381-0977
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0386291Medicaid