TERRELL JASON FORTUNE

SAN MATEO, CA
NPI1720349731
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2012-06-06
Last Update Date2012-06-06
Business Address
-- TERRELL JASON FORTUNE
720 S. B ST.
SAN MATEO, CA 94401
Phone number: 650-579-7157
Mailing Address
-- TERRELL JASON FORTUNE
720 S. B ST.
SAN MATEO, CA 94401
Phone number: 650-579-7157
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