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NPI Code Detail

MEDICARE: AMINA PORTER PHD

MEDICARE: AMINA PORTER PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLPC004768GA
2103T00000XPsychologistPSY003528GA

General Provider Information

NPI Number : 1659433696
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMINA PORTER PHD
Provider Business Mailing Address
First Line : 1077R GLENDALE DR
Second Line :
City : EAST POINT
State : GA
Zip : 30344-2820
Country : US
Telephone Number : 404-409-4500
Fax Number : 404-766-3589
Provider Business Practice Location Address
First Line : 30 WARREN ST SE
Second Line :
City : ATLANTA
State : GA
Zip : 30317-2267
Country : US
Telephone Number : 404-373-6614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2006
Last Update Date : 03/17/2018

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Directions to “ AMINA PORTER PHD” Practice Location

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