Provider Demographics
NPI:1942868088
Name:PORTER, DELIA (CSAC)
Entity Type:Individual
Prefix:MRS
First Name:DELIA
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:MRS
Other - First Name:DELIA
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAADC
Mailing Address - Street 1:270 HALLOCK PL APT 2
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-3178
Mailing Address - Country:US
Mailing Address - Phone:276-238-7876
Mailing Address - Fax:
Practice Address - Street 1:353 FALLS DR NW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-8093
Practice Address - Country:US
Practice Address - Phone:276-608-8486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2137101YA0400X
VA0710102947101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)