Provider Demographics
NPI:1043840523
Name:PORTER, TRINAE
Entity type:Individual
Prefix:
First Name:TRINAE
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26603 GADING RD APT 226
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-3632
Mailing Address - Country:US
Mailing Address - Phone:816-226-2055
Mailing Address - Fax:
Practice Address - Street 1:26603 GADING RD APT 226
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-3632
Practice Address - Country:US
Practice Address - Phone:816-226-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor