Healthcare Provider Details

I. General information

NPI: 1043123441
Provider Name (Legal Business Name): CAMILA PORTO HARPER ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAMILA NUNES PORTO

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1247 RUCKER BLVD STE 6
ENTERPRISE AL
36330-3630
US

IV. Provider business mailing address

PO BOX 273
NEW BROCKTON AL
36351-0273
US

V. Phone/Fax

Practice location:
  • Phone: 334-237-3838
  • Fax:
Mailing address:
  • Phone: 334-464-4324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberALC06181
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: