Provider Demographics
NPI:1861728669
Name:TRUETT-PORTER, TAMMY (CSAC)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:
Last Name:TRUETT-PORTER
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 SECRET COVE CT
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-5583
Mailing Address - Country:US
Mailing Address - Phone:845-591-3626
Mailing Address - Fax:
Practice Address - Street 1:4293 HIGHWAY 24 27 E STE D
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:NC
Practice Address - Zip Code:28107-8500
Practice Address - Country:US
Practice Address - Phone:704-888-2380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)