Provider Demographics
NPI:1295187763
Name:PORTER, MONIQUE (LCMHC, LCAS)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:LCMHC, LCAS
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5720 FAYETTEVILLE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5333
Mailing Address - Country:US
Mailing Address - Phone:919-576-0084
Mailing Address - Fax:919-797-9922
Practice Address - Street 1:5720 FAYETTEVILLE RD STE 202
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5333
Practice Address - Country:US
Practice Address - Phone:919-576-0084
Practice Address - Fax:919-797-9922
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12195101YP2500X, 101YM0800X
NC21682101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)