Provider Demographics
NPI:1104570977
Name:PORTER, CHELSEA (LMSW)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2620 EXECUTIVE PL
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-3717
Mailing Address - Country:US
Mailing Address - Phone:228-385-7744
Mailing Address - Fax:
Practice Address - Street 1:2620 EXECUTIVE PL
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-3717
Practice Address - Country:US
Practice Address - Phone:228-385-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM9866104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker