Provider Demographics
NPI:1215222559
Name:PORTER, WILLIAM (LCDC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:PORTER
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 GLENCREST LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5137
Mailing Address - Country:US
Mailing Address - Phone:903-753-7633
Mailing Address - Fax:903-753-0574
Practice Address - Street 1:708 GLENCREST LN
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5137
Practice Address - Country:US
Practice Address - Phone:903-753-7633
Practice Address - Fax:903-753-0574
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10304101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10304OtherLICENSED CHEMICAL DEPENDENCY COUNSELOR