Provider Demographics
NPI:1336763192
Name:PORTER, TAMMY (PSC, LAPC, NCC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:PSC, LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SW BROAD ST
Mailing Address - Street 2:
Mailing Address - City:METTER
Mailing Address - State:GA
Mailing Address - Zip Code:30439-4433
Mailing Address - Country:US
Mailing Address - Phone:912-515-5026
Mailing Address - Fax:
Practice Address - Street 1:5 SW BROAD ST
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-4433
Practice Address - Country:US
Practice Address - Phone:912-515-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-07
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAX101YA0400X, 101YS0200X
GALAPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool