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General NPI Number Information
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NPI Number | 1902617996
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Entity Type | Individual
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Provider Name | MICKI PORTER
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Gender | Female
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 4513 COUNTY ROAD 12
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City | PROCTORVILLE
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State | OH
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Zip | 45669-8304
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Country | US
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Telephone | 740-222-9103
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Fax |
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Provider Business Mailing Address
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Address Line | 4513 COUNTY ROAD 12
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City | PROCTORVILLE
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State | OH
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Zip | 45669-8304
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Country | US
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Telephone | 740-222-9103
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | OH
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