Provider Demographics
NPI:1871918276
Name:PORTER, CANDRA NATOSHA (LCSW)
Entity type:Individual
Prefix:
First Name:CANDRA
Middle Name:NATOSHA
Last Name:PORTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 LENOX RD NE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1394
Mailing Address - Country:US
Mailing Address - Phone:404-250-3255
Mailing Address - Fax:404-504-7004
Practice Address - Street 1:3355 LENOX RD NE
Practice Address - Street 2:SUITE 600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1394
Practice Address - Country:US
Practice Address - Phone:404-250-3255
Practice Address - Fax:404-504-7004
Is Sole Proprietor?:No
Enumeration Date:2014-02-22
Last Update Date:2014-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0050401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical