Healthcare Provider Details

I. General information

NPI: 1801509856
Provider Name (Legal Business Name): FORTIFY CHRISTIAN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4958 VALLEYDALE RD STE 250
HOOVER AL
35242-7723
US

IV. Provider business mailing address

140 PIN OAK DR
CHELSEA AL
35043-5213
US

V. Phone/Fax

Practice location:
  • Phone: 205-677-6067
  • Fax: 205-588-0786
Mailing address:
  • Phone: 205-677-6067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN THREADCRAFT
Title or Position: FOUNDER
Credential: LPC
Phone: 205-677-6067