Healthcare Provider Details

I. General information

NPI: 1376107813
Provider Name (Legal Business Name): FORTITUDE COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 OXON HILL RD STE 210
OXON HILL MD
20745-1124
US

IV. Provider business mailing address

137 NATIONAL PLZ STE 300
OXON HILL MD
20745-1153
US

V. Phone/Fax

Practice location:
  • Phone: 240-863-2820
  • Fax:
Mailing address:
  • Phone: 240-863-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CORNEALIUS L STAMPS
Title or Position: DIRECTOR
Credential: LCSW, LCSW-C
Phone: 240-863-2820