Provider Demographics
NPI:1225329741
Name:PORTER, KAREN K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:K
Last Name:PORTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:P
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2550 WINDY HILL RD SE
Mailing Address - Street 2:STE 215
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8665
Mailing Address - Country:US
Mailing Address - Phone:770-850-8464
Mailing Address - Fax:770-850-9727
Practice Address - Street 1:313 BOYNTON DR
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2737
Practice Address - Country:US
Practice Address - Phone:706-935-3926
Practice Address - Fax:706-935-3930
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0045251041C0700X
TNLSW00000000781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I809052Medicare PIN