| The Portlock Group, Pllc | |
|
4935 Albemarle Rd Charlotte NC 28205-6617 | |
| (704) 780-9628 | |
| (704) 566-9038 |
| Full Name | The Portlock Group, Pllc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 4935 Albemarle Rd, Charlotte, North Carolina |
| Authorized Official Name and Position | Stepfon Teonta Portlock (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7047809628 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Portlock Group, Pllc Po Box 505 Newell NC 28126-0505 Ph: (704) 780-9628 | The Portlock Group, Pllc 4935 Albemarle Rd Charlotte NC 28205-6617 Ph: (704) 780-9628 |
| NPI Number | 1770901407 |
|---|---|
| Provider Enumeration Date | 03/31/2014 |
| Last Update Date | 03/31/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770901407 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C008189 (North Carolina) | Primary |
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