Provider Demographics
NPI:1578395539
Name:PORTER, VIRGINIA LEE (LMHP, MSW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LEE
Last Name:PORTER
Suffix:
Gender:F
Credentials:LMHP, MSW
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:LEE
Other - Last Name:FROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHP, MSW
Mailing Address - Street 1:4709 N 168TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-3010
Mailing Address - Country:US
Mailing Address - Phone:402-850-8541
Mailing Address - Fax:
Practice Address - Street 1:9239 W CENTER RD STE 201
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1900
Practice Address - Country:US
Practice Address - Phone:402-354-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21651041C0700X
WYLCSW-17381041C0700X
NE5878101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical