The Portlock Group, PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C008189 Issued in NC

Legal business name

THE PORTLOCK GROUP, PLLC

Practice address

4935 Albemarle Rd
Charlotte, NC 28205-6617

Phone

(704) 780-9628

Fax

(704) 566-9038

NPI assigned

Mar 31, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Stepfon Teonta Portlock, LCSW

Title

Clinical Director

Phone

(704) 780-9628

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1396224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396224000000",
    "number": "1770901407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 505",
            "city": "NEWELL",
            "state": "NC",
            "postal_code": "281260505",
            "telephone_number": "704-780-9628",
            "fax_number": "704-566-9038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4935 ALBEMARLE RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282056617",
            "telephone_number": "704-780-9628",
            "fax_number": "704-566-9038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PORTLOCK GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-31",
        "last_updated": "2014-03-31",
        "status": "A",
        "authorized_official_last_name": "PORTLOCK",
        "authorized_official_first_name": "STEPFON",
        "authorized_official_middle_name": "TEONTA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "704-780-9628",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C008189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.