Provider Demographics
NPI:1184012791
Name:PORTER, BILLIE GRAY
Entity Type:Individual
Prefix:MRS
First Name:BILLIE
Middle Name:GRAY
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W HOLLY HILL RD APT 24
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-5756
Mailing Address - Country:US
Mailing Address - Phone:336-307-0193
Mailing Address - Fax:
Practice Address - Street 1:50 W HOLLY HILL RD APT 24
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5756
Practice Address - Country:US
Practice Address - Phone:336-307-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC000987104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker