Most Relevant Information
Provider Data
| NPI Number: | 1003316720 |
| Provider Name: | WILLIAM DOUGLAS PORTIS LCPC CADC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 33398 |
Most Important Dates
| Enumeration Date: | 02/19/2018 |
| Last Updated: | 09/11/2020 |
Provider Practice Location
808 S ELDORADO RD STE 100C
BLOOMINGTON
IL
617046075
Practice Location Phone/Fax
| Phone: | 3098896222 |
| Fax: |
Provider Mailing Location
1 PLANTATION CT
BLOOMINGTON
IL
617049467
Provider Mailing Phone/Fax
| Phone: | 3098896222 |
| Fax: |