Provider Demographics
NPI:1760006910
Name:PORTER, HAILIE (LMSW)
Entity type:Individual
Prefix:
First Name:HAILIE
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-3312
Mailing Address - Country:US
Mailing Address - Phone:248-763-3523
Mailing Address - Fax:
Practice Address - Street 1:6060 DIXIE HWY STE H
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3476
Practice Address - Country:US
Practice Address - Phone:248-455-6619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801117894104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1335Medicaid