Individual
BRANDY K PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CAADC
Contact information
Practice address
5905 STEWART PKWY, DOUGLASVILLE, GA 30135-2371
(770) 949-8082
Mailing address
5905 STEWART PKWY, DOUGLASVILLE, GA 30135-2371
(770) 949-8082
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C0245
GA
1041C0700X
Clinical Social Worker
Primary
MSW008124
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982078382
—
GA
Enumeration date
11/23/2015
Last updated
05/21/2019
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