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1245768308
DOMINIQUE FORTSON-JORDAN
TACOMA, WA
NPI
1245768308
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WA 60597844)
Enumeration Date
2017-06-01
Last Update Date
2017-06-01
Business Address
DOMINIQUE FORTSON-JORDAN CDP
758 ST HELENS AVE
TACOMA, WA 98402-3706
Phone number: 253-274-0484
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Mailing Address
DOMINIQUE FORTSON-JORDAN CDP
758 ST HELENS AVE
TACOMA, WA 98402-3706
Phone number:
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