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General NPI Number Information
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NPI Number | 1134784143
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Entity Type | Individual
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Provider Name | CINDI MICHELE PORTER AAC
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Gender | Female
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 2428 W REYNOLDS AVE
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City | CENTRALIA
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State | WA
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Zip | 98531-4554
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Country | US
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Telephone | 360-623-8020
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Fax | 360-623-1084
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Provider Business Mailing Address
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Address Line | COMPREHENSIVE LIFE RESOURCES 1305 TACOMA AVENUE SOUTH
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City | TACOMA
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State | WA
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Zip | 98402-1903
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CG60806049
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License Number State | WA
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