Provider Demographics
NPI:1619349156
Name:PORTER, NORMA BIANCA (PLPC)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:BIANCA
Last Name:PORTER
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PLPC
Mailing Address - Street 1:61197 HIGHWAY 1046
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-4423
Mailing Address - Country:US
Mailing Address - Phone:985-687-9044
Mailing Address - Fax:225-291-9692
Practice Address - Street 1:725 WESTIN OAKS DR STE 200
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-3455
Practice Address - Country:US
Practice Address - Phone:985-235-0076
Practice Address - Fax:985-235-0077
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600751961Medicaid