Healthcare Provider Details

I. General information

NPI: 1538082052
Provider Name (Legal Business Name): WILLIAM LEE FORTESCUE LCMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 MAPLE GROVE CHURCH RD
DUNN NC
28334-7688
US

IV. Provider business mailing address

1508 MAPLE GROVE CHURCH RD
DUNN NC
28334-7688
US

V. Phone/Fax

Practice location:
  • Phone: 877-935-5255
  • Fax:
Mailing address:
  • Phone: 336-909-4788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22403
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: