Provider Demographics
NPI:1538780366
Name:MAYE, PORTIA SHANTEZ
Entity type:Individual
Prefix:
First Name:PORTIA
Middle Name:SHANTEZ
Last Name:MAYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2084 REDPINE DR
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-7368
Mailing Address - Country:US
Mailing Address - Phone:251-545-8133
Mailing Address - Fax:
Practice Address - Street 1:2084 REDPINE DR
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-7368
Practice Address - Country:US
Practice Address - Phone:251-545-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker