Individual provider Active NPI

Portia Lawrence, LCMHC, NCC, R-DMT

  • Mental Health Counselor
  • Brattleboro, VT
National Provider Identifier
1306364278
Registry record updated Apr 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
068.0131607 Issued in VT
Practice address
139 Main St Ste 612
Brattleboro, VT 05301-2886
Phone
(857) 540-9818
NPI assigned
Aug 31, 2017
Last updated
Apr 2, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 068.0131607 VT Primary

Addresses

Primary practice location

139 Main St Ste 612
Brattleboro, VT 05301-2886

Mailing address

139 Main St RM 613
Brattleboro, VT 05301-2874

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Jan 17, 2024 through Jan 17, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
068.0131607VTMDMental Health Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617321600000",
    "number": "1306364278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 MAIN ST RM 613",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053012874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 MAIN ST STE 612",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053012886",
            "telephone_number": "857-540-9818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWRENCE",
        "first_name": "PORTIA",
        "credential": "LCMHC, NCC, R-DMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-31",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VT",
            "license": "068.0131607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brattleboro, VT

Sources for this page

Verify at the official NPI Registry.