Most Relevant Information
Provider Data
| NPI Number: | 1003322652 |
| Provider Name: | ERIKA LANETTE PORTILLO M.ED, LMHP-R |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/19/2017 |
| Last Updated: | 12/19/2017 |
Provider Practice Location
3541 CHAIN BRIDGE RD STE 204
FAIRFAX
VA
220302793
Practice Location Phone/Fax
| Phone: | 7032186599 |
| Fax: | 7032182012 |
Provider Mailing Location
3541 CHAIN BRIDGE RD STE 204
FAIRFAX
VA
220302793
Provider Mailing Phone/Fax
| Phone: | 7032186599 |
| Fax: | 7032182012 |