Individual provider · Type 1 NPI

Theresa Porter, RADT

Addiction (Substance Use Disorder) Counselor · Fairfield, CA

NPI number 1659138147 Active

Practice location

1225 Travis Blvd
Fairfield, CA 94533-4892

Call (707) 399-9105 Map

Mailing address

609 Jefferson St
Fairfield, CA 94533-6293

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XR1518650823 (CA)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1659138147

Theresa Porter, RADT's National Provider Identifier is 1659138147, issued on Mar 1, 2024. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Fairfield, CA. The record was last updated on Mar 1, 2024.