Portis, Clyte Lydia
Portis, Clyte Lydia is an individual health care provider with primary practice located at 254 41St St Bldg 40709, Fort Gordon GA 30905-5918. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Social Worker, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / School. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Portis, Clyte Lydia can be contacted via phone (707) 787-1595.Contact Information
Primary practice address
254 41St St Bldg 40709
Fort Gordon GA 30905-5918
Phone: (707) 787-1595
Fax: (706) 787-1099
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Social Worker | 104100000X | CSW003792 | Georgia |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | CSW003792 | Georgia |
| Behavioral Health & Social Service Providers / School | 1041S0200X | CSW003792 | Georgia |
Profile Details
| NPI number | 1447423157 |
|---|---|
| LBN Legal business name | Portis, Clyte Lydia |
| Credentials | LCSW, LISW-CP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 2nd, 2008 |
| Last updated | Oct 29th, 2013 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1447423157 | NPPES |
| Georgia | Other | CSW003792 | GA SOCIAL WORK LICENSURE |
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