| NPI | 1255873709 |
|---|---|
| Former Name | DOROTHY A. FORTUCHANG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC007651) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA 508802) |
| 101YM0800X Counselor, Mental Health (Licence: GA LPC007651) | |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2019-02-12 |