Provider Demographics
NPI:1841808136
Name:PORTER, DARREIAN
Entity type:Individual
Prefix:
First Name:DARREIAN
Middle Name:
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 1:255 OLD VIKING DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-7579
Mailing Address - Country:US
Mailing Address - Phone:606-784-2774
Mailing Address - Fax:
Practice Address - Street 1:255 OLD VIKING DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-7579
Practice Address - Country:US
Practice Address - Phone:067-842-7746
Practice Address - Fax:606-886-4433
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health