Basic Information
| Provider Information | |||||||||
| NPI: | 1912317496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORT | ||||||||
| FirstName: | MARCIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 413 E SPRUCE ST | ||||||||
| Address2: | MOUNT VERNON | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982732951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604190429 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1300 NE GOLDIE ST | ||||||||
| Address2: | |||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982774832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602404043 | ||||||||
| FaxNumber: | 3606751440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2014 | ||||||||
| LastUpdateDate: | 05/05/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LW60160445 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.