Provider Demographics
NPI:1679147466
Name:PORTER, ALICIA ALLISON (LPC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ALLISON
Last Name:PORTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4135
Mailing Address - Country:US
Mailing Address - Phone:404-797-1849
Mailing Address - Fax:
Practice Address - Street 1:1360 CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4135
Practice Address - Country:US
Practice Address - Phone:404-797-1849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health