Provider Demographics
NPI:1366585804
Name:PORTMAN, MICHELLE DIANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DIANNE
Last Name:PORTMAN
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 1:111 CENTER PARK DR
Mailing Address - Street 2:STE 1300
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2124
Mailing Address - Country:US
Mailing Address - Phone:865-555-0593
Mailing Address - Fax:
Practice Address - Street 1:111 CENTER PARK DR
Practice Address - Street 2:STE 1300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2124
Practice Address - Country:US
Practice Address - Phone:865-556-0593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000038891041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical