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General NPI Number Information
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NPI Number | 1417440447
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Entity Type | Individual
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Provider Name | DANA JEAN DORTICOS LAC,ADC,IADC,CADCIII
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Gender | Female
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 58945 BUSINESS CENTER DR
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-7307
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Country | US
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Telephone | 760-369-1074
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Fax | 760-369-1293
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Provider Business Mailing Address
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Address Line | 1882 N TAMIAMI TRL UNIT 3136
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City | NORTH FORT MYERS
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State | FL
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Zip | 33918-2506
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Country | US
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Telephone | 760-774-3729
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 01865
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License Number State | KS
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