Provider Demographics
NPI:1427645589
Name:PORTER, KAREN SUE (MED, LGPC)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:PORTER
Suffix:
Gender:F
Credentials:MED, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 DIXON ST UNIT 405
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3656
Mailing Address - Country:US
Mailing Address - Phone:410-924-3816
Mailing Address - Fax:
Practice Address - Street 1:300 DIXON ST UNIT 405
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3656
Practice Address - Country:US
Practice Address - Phone:410-924-3816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10075101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health