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General NPI Number Information
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NPI Number | 1063118776
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Entity Type | Organization
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Legal Business Name | FORTITUDE WELLNESS COLLECTIVE, LLC
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Dates
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Enumeration Date | 02/03/2023
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Last Update Date | 02/05/2023
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Provider Practice Location Address
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Address Line | 3922 VERMONT AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22304-6325
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Country | US
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Telephone | 202-505-1916
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Fax |
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Provider Business Mailing Address
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Address Line | 712 H ST NE STE 1851
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City | WASHINGTON
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State | DC
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Zip | 20002-3627
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Country | US
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Telephone | 202-505-1916
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | RASHONDA IESHA RILEY
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Credential | LCSW, LICSW
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Telephone | 228-218-3593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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