| Doctor Name: | MRS. MICHELLE DIANNE PORTMAN |
| NPI Number: | 1366585804 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 0000003889 |
| Business Practice Address: | 1206 Hwy 411 Vonore, TN - 37885 |
| Business Phone Number: | 4238847271 |
| Business Fax Number: | 4238843277 |
| Mailing Address: | Po Box 278, MADISONVILLE |
| State: | TN |
| Postal Code: | 37354 |
| Phone Number: | 4234422622 |
| Fax Number: | 4234423334 |
| NPI Enumeration Date: | 02/15/2007 |
| NPI Last Update Date: | 08/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 0000003889 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |