Individual
DOMINIQUE FORTSON-JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDP
Contact information
Practice address
758 ST HELENS AVE, TACOMA, WA 98402-3706
(253) 274-0484
Mailing address
758 ST HELENS AVE, TACOMA, WA 98402-3706
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
60597844
WA
Other
Enumeration date
06/01/2017
Last updated
06/01/2017
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