Provider Demographics
NPI:1043495625
Name:PORTER, WENDY ELISE (LADC)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ELISE
Last Name:PORTER
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-6304
Mailing Address - Country:US
Mailing Address - Phone:603-455-5203
Mailing Address - Fax:
Practice Address - Street 1:56 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253-6304
Practice Address - Country:US
Practice Address - Phone:603-455-5203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0614101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)