Provider Demographics
NPI:1689329401
Name:PORTER, KASSANDRA DENAY (LSW)
Entity Type:Individual
Prefix:MISS
First Name:KASSANDRA
Middle Name:DENAY
Last Name:PORTER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BRENTRIDGE DR # 120
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3737
Mailing Address - Country:US
Mailing Address - Phone:662-274-8686
Mailing Address - Fax:
Practice Address - Street 1:640 GRASSMERE PARK STE 116
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3678
Practice Address - Country:US
Practice Address - Phone:615-866-8922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician