Provider Demographics
NPI:1760586390
Name:PORTIS, RAMONA DOLORES (CASE MANAGER-CAC-M)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:DOLORES
Last Name:PORTIS
Suffix:
Gender:F
Credentials:CASE MANAGER-CAC-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-5602
Mailing Address - Country:US
Mailing Address - Phone:810-824-4485
Mailing Address - Fax:
Practice Address - Street 1:1406 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5804
Practice Address - Country:US
Practice Address - Phone:810-987-1258
Practice Address - Fax:810-987-3505
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)