Individual provider · Type 1 NPI
Terrell Jason Fortune
Addiction (Substance Use Disorder) Counselor · San Mateo, CA
NPI number
1720349731
Active
Practice location
720 S. B St.
San Mateo, CA 94401
Fax (650) 579-5530
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | None listed |
Addiction (Substance Use Disorder) Counselor: Definition to come...
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About NPI 1720349731
Terrell Jason Fortune's National Provider Identifier is 1720349731, issued on Jun 6, 2012. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in San Mateo, CA. The record was last updated on Jun 6, 2012.