Provider Demographics
NPI:1538533666
Name:PORTER, RICHARD JR
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:PORTER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 SOUND DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28512-5205
Mailing Address - Country:US
Mailing Address - Phone:252-269-0199
Mailing Address - Fax:
Practice Address - Street 1:3110 ARENDELL ST
Practice Address - Street 2:#4
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-6511
Practice Address - Country:US
Practice Address - Phone:252-269-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCSAC-21997101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)