Provider Demographics
NPI:1285421214
Name:PORTER, TAYSIA EMARI
Entity type:Individual
Prefix:
First Name:TAYSIA
Middle Name:EMARI
Last Name:PORTER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 GOLDEN GROVE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-5908
Mailing Address - Country:US
Mailing Address - Phone:912-414-3484
Mailing Address - Fax:
Practice Address - Street 1:2545 NE COACHMAN RD APT 40
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1806
Practice Address - Country:US
Practice Address - Phone:912-414-3484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician