Basic Information
| Provider Information | |||||||||
| NPI: | 1083698120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PORTER | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | SHERYL | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PRITCHETT | ||||||||
| OtherFirstName: | DAWN | ||||||||
| OtherMiddleName: | SHERYL | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13193 CENTRAL AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917107200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099029111 | ||||||||
| FaxNumber: | 9099029199 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 WEST BASELINE ROAD | ||||||||
| Address2: | STE 3 | ||||||||
| City: | CLAIRMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099029111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS20398 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.