Provider Demographics
NPI:1295245967
Name:PORTER, VINCENT MCADAM
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:MCADAM
Last Name:PORTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 VERSAILLES ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2216
Mailing Address - Country:US
Mailing Address - Phone:361-676-8466
Mailing Address - Fax:
Practice Address - Street 1:303 E AIRLINE RD STE 4
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3957
Practice Address - Country:US
Practice Address - Phone:361-575-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63598101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor