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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447423157 NPPES
Georgia Other CSW003792 GA SOCIAL WORK LICENSURE

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