Provider Demographics
NPI:1699562678
Name:PORTER, SHALONDA FIRESHA
Entity type:Individual
Prefix:
First Name:SHALONDA
Middle Name:FIRESHA
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 GEORGE BUSBEE PKWY NW # 1422
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6807
Mailing Address - Country:US
Mailing Address - Phone:770-670-3372
Mailing Address - Fax:
Practice Address - Street 1:3350 NORTHLAKE PKWY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2204
Practice Address - Country:US
Practice Address - Phone:404-966-0273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health