| Porters Headspace | |
|
4212 Lennon Rd Ste 1 Flint MI 48507-1080 | |
| (810) 293-5063 | |
| Not Available |
| Full Name | Porters Headspace |
|---|---|
| Speciality | Social Worker |
| Location | 4212 Lennon Rd Ste 1, Flint, Michigan |
| Authorized Official Name and Position | Rebecca Marie Porter (OWNER) |
| Authorized Official Contact | 8102935063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Porters Headspace Po Box 320797 Flint MI 48532-0014 Ph: (810) 293-5063 | Porters Headspace 4212 Lennon Rd Ste 1 Flint MI 48507-1080 Ph: (810) 293-5063 |
| NPI Number | 1790477180 |
|---|---|
| Provider Enumeration Date | 05/23/2023 |
| Last Update Date | 08/28/2023 |
| Certification Date | 08/28/2023 |
| Medicare PECOS PAC ID | 3577927086 |
|---|---|
| Medicare Enrollment ID | O20230918001993 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790477180 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Rebecca M Porter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386072528 PECOS PAC ID: 9234466988 Enrollment ID: I20190805000438 |
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