Provider Demographics
NPI:1144661778
Name:PORTER, PAMELA LORENE (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:LORENE
Last Name:PORTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:LORENE
Other - Last Name:FOUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-0048
Mailing Address - Country:US
Mailing Address - Phone:765-215-0584
Mailing Address - Fax:877-610-3921
Practice Address - Street 1:201 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47305-1617
Practice Address - Country:US
Practice Address - Phone:765-215-0584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1282264104100000X
IN34003296A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker