Individual
PORTER HOLIDAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
10633 MCMICHAEL LN SW, ALBUQUERQUE, NM 87121
(505) 710-5877
Mailing address
10633 MCMICHAEL LN SW, ALBUQUERQUE, NM 87121-3689
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-10047
NM
1041C0700X
Clinical Social Worker
M-08603
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
73558524
—
NM
Enumeration date
07/29/2008
Last updated
09/07/2018
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