Individual
MISS JESSICA BROOKE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S, FAODP
Contact information
Practice address
1435 N OAKLAND BLVD, WATERFORD, MI 48327-1549
(248) 666-2720
Mailing address
1147 IRONWOOD CT, APT 004, ROCHESTER, MI 48307-1261
(248) 909-0189
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
08/30/2006
Last updated
07/08/2007
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