Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | L0487 | OR |
NPI | 1003979246 |
---|---|
Provider Name | Mark A Mortier |
First Address | Ft Wainwright, AK 99703-7440 |
Second Address | Ft Wainwright, AK 99703-7440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 08/07/2007 |