Healthcare Provider Details

I. General information

NPI: 1669096012
Provider Name (Legal Business Name): MICHAEL PORTERFIELD MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 BUSTER RD
ASHFORD AL
36312-5663
US

IV. Provider business mailing address

387 BUSTER RD
ASHFORD AL
36312-5663
US

V. Phone/Fax

Practice location:
  • Phone: 334-200-3675
  • Fax:
Mailing address:
  • Phone: 334-200-3675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4377C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: