Healthcare Provider Details

I. General information

NPI: 1134859549
Provider Name (Legal Business Name): JAMES ALBERT FORTUNE JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GREEN RD STE N
ANN ARBOR MI
48105-2948
US

IV. Provider business mailing address

2200 GREEN RD STE N
ANN ARBOR MI
48105-2948
US

V. Phone/Fax

Practice location:
  • Phone: 248-573-7417
  • Fax:
Mailing address:
  • Phone: 248-573-7417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013073
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: