Provider Demographics
NPI:1336484971
Name:PORTER, MOLLY B (MS MFT)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:B
Last Name:PORTER
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 FAWNWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-4100
Mailing Address - Country:US
Mailing Address - Phone:229-560-2117
Mailing Address - Fax:
Practice Address - Street 1:2908 FAWNWOOD CIR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-4100
Practice Address - Country:US
Practice Address - Phone:229-560-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-09
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist