Individual
MARY THERESE FORTIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
230 W BERDINE ST, 1813 W. HARVARD, SUITE 230, ROSEBURG, OR 97470-2203
(541) 440-3715
Mailing address
230 W BERDINE ST, 1813 W. HARVARD, SUITE 230, ROSEBURG, OR 97470-2203
(541) 440-3715
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L2416
OR
Other
Enumeration date
06/04/2007
Last updated
07/08/2007
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