Provider Demographics
NPI:1861744831
Name:PORTER, DEBRA CAROL (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:CAROL
Last Name:PORTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:CAROL
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:112 NEW HOPE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-7685
Mailing Address - Country:US
Mailing Address - Phone:276-759-2982
Mailing Address - Fax:
Practice Address - Street 1:112 NEW HOPE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-7685
Practice Address - Country:US
Practice Address - Phone:276-759-2982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12329235Z00000X
VA2202002762235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist