Provider Demographics
NPI:1750002226
Name:PORE, JANE' L (MSW, LCAS-A , LCSW-A)
Entity type:Individual
Prefix:
First Name:JANE'
Middle Name:L
Last Name:PORE
Suffix:
Gender:F
Credentials:MSW, LCAS-A , LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 WACO AVE
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6364
Mailing Address - Country:US
Mailing Address - Phone:704-956-5345
Mailing Address - Fax:
Practice Address - Street 1:5108 REAGAN DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28296-6364
Practice Address - Country:US
Practice Address - Phone:704-332-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical