Provider Demographics
NPI:1932739117
Name:PORTER, NANCI DAWN (CADC)
Entity Type:Individual
Prefix:MS
First Name:NANCI
Middle Name:DAWN
Last Name:PORTER
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:MS
Other - First Name:NANCI
Other - Middle Name:DAWN
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHRT11
Mailing Address - Street 1:PO BOX 5661
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04332-5661
Mailing Address - Country:US
Mailing Address - Phone:207-557-2509
Mailing Address - Fax:
Practice Address - Street 1:8 SUMMER ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5129
Practice Address - Country:US
Practice Address - Phone:207-557-2509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5425101YA0400X
MEMHRT2101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)