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General NPI Number Information
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NPI Number | 1861122400
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Entity Type | Individual
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Provider Name | DR. CHRISTOPHER A PORCH
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Gender | Male
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 58 MEADOW VALLEY CT
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City | MIDLAND
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State | GA
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Zip | 31820-4393
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Country | US
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Telephone | 706-593-9687
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Fax |
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Provider Business Mailing Address
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Address Line | 58 MEADOW VALLEY CT
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City | MIDLAND
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State | GA
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Zip | 31820-4393
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Country | US
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Telephone | 706-593-9687
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMHC10000193
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC012496
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License Number State | GA
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