Individual
SHANI PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24 JOE KENNEDY BLVD STE 13, STATESBORO, GA 30458-3113
(912) 208-2024
Mailing address
2805 S INDUSTRIAL HWY STE 100, ANN ARBOR, MI 48104-6791
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
05/21/2019
Last updated
09/13/2024
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