Provider Demographics
NPI:1457164709
Name:PORTER, CANDY DENISE (ALC)
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:DENISE
Last Name:PORTER
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35046-0755
Mailing Address - Country:US
Mailing Address - Phone:205-229-5522
Mailing Address - Fax:
Practice Address - Street 1:272 WELLNESS CENTER DR
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2377
Practice Address - Country:US
Practice Address - Phone:205-280-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC05170101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional