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1659138147
THERESA PORTER
FAIRFIELD, CA
NPI
1659138147
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA R1518650823)
Enumeration Date
2024-03-01
Last Update Date
2024-03-01
Business Address
THERESA PORTER RADT
1225 TRAVIS BLVD
FAIRFIELD, CA 94533-4892
Phone number: 707-399-9105
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Mailing Address
THERESA PORTER RADT
609 JEFFERSON ST
FAIRFIELD, CA 94533-6293
Phone number: 916-759-3023
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