Healthcare Provider Details

I. General information

NPI: 1629831565
Provider Name (Legal Business Name): FORTUIDE WELLBEING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 4TH AVE
INDIALANTIC FL
32903-4213
US

IV. Provider business mailing address

1150 MALABAR RD SE STE 111-125
PALM BAY FL
32907-3239
US

V. Phone/Fax

Practice location:
  • Phone: 321-325-6935
  • Fax: 321-325-6840
Mailing address:
  • Phone: 321-325-6935
  • Fax: 321-325-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN HIX
Title or Position: OWNER/MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 321-325-6935