Healthcare Provider Details

I. General information

NPI: 1659797819
Provider Name (Legal Business Name): PORTER MCKEE LCSW--CADCII
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST STE 455
JACKSON MS
39202-2000
US

IV. Provider business mailing address

1000 URBAN CENTER DR STE 600
VESTAVIA AL
35242-2584
US

V. Phone/Fax

Practice location:
  • Phone: 601-957-7343
  • Fax: 601-351-4850
Mailing address:
  • Phone: 205-208-9312
  • Fax: 205-848-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC7488
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAD03-35M
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: