Theresa Porter, RADT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

R1518650823 Issued in CA

Practice address

1225 Travis Blvd
Fairfield, CA 94533-4892

Phone

(707) 399-9105

NPI assigned

Mar 1, 2024

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

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

{
    "created_epoch": "1709251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709251200000",
    "number": "1659138147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 JEFFERSON ST",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945336293",
            "telephone_number": "916-759-3023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 TRAVIS BLVD",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945334892",
            "telephone_number": "707-399-9105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "THERESA",
        "credential": "RADT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-01",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1518650823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caleb Poon
• Kulbir K Pooni
• Hailey Ann Popovich
• Nicole Diana Porter
• Nina Porter, MD
• Auxsophene L Portier-Jones, PA
• Monica Portigliatti Pomeri, M.S. CCC-SLP
• Amanda Raquel Portillo, MFTI
• Sara Portillo
• Adrianna Portugal

• Addiction (Substance Use Disorder) Counselor in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; 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.