Dominique Fortson-Jordan, CDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

60597844 Issued in WA

Practice address

758 St Helens Ave
Tacoma, WA 98402-3706

Phone

(253) 274-0484

NPI assigned

Jun 1, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pioneer Counseling Tacoma

  • Exclusive Provider Organization
  • Tacoma, WA
  • NPI 1073971933
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496275200000",
    "number": "1245768308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "758 ST HELENS AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984023706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "758 ST HELENS AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984023706",
            "telephone_number": "253-274-0484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTSON-JORDAN",
        "first_name": "DOMINIQUE",
        "credential": "CDP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-01",
        "last_updated": "2017-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "60597844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony J Forte
• Demetrius Laval Forte Sr., LPN
• Dominic Mario Forte, MD
• Thomas Forte
• Robert Roland Fortney
• Forward Movement Recovery
• Terra Forward
• Christian Richard Fosler, ATC
• Joseph Michael Foss, APRN, FNP-C
• Tory James Foss, PA-C

• Addiction (Substance Use Disorder) Counselor in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.