Healthcare Provider Details

I. General information

NPI: 1841808136
Provider Name (Legal Business Name): DARREIAN PORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 OLD VIKING DR
MOREHEAD KY
40351-7579
US

IV. Provider business mailing address

255 OLD VIKING DR
MOREHEAD KY
40351-7579
US

V. Phone/Fax

Practice location:
  • Phone: 67-842-7746
  • Fax: 606-886-4433
Mailing address:
  • Phone: 606-784-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: