Provider Demographics
NPI:1326189127
Name:PORTER, MELIA BROOKE (LCSW)
Entity Type:Individual
Prefix:
First Name:MELIA
Middle Name:BROOKE
Last Name:PORTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2259 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3325
Mailing Address - Country:US
Mailing Address - Phone:707-444-8293
Mailing Address - Fax:707-444-8298
Practice Address - Street 1:2259 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3325
Practice Address - Country:US
Practice Address - Phone:707-444-8293
Practice Address - Fax:707-444-8298
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW244721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical