Provider Demographics
NPI:1932947470
Name:PORTER, ABBY MADISON (RBT)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:MADISON
Last Name:PORTER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1889 ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-3729
Mailing Address - Country:US
Mailing Address - Phone:334-493-5712
Mailing Address - Fax:
Practice Address - Street 1:500 S BRUNDIDGE ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3334
Practice Address - Country:US
Practice Address - Phone:334-493-5712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-24-355235106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician