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General NPI Number Information
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NPI Number | 1407571599
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Entity Type | Organization
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Legal Business Name | FORTIS BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 10/11/2022
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Last Update Date | 11/30/2025
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Provider Practice Location Address
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Address Line | 4904 FAYETTEVILLE RD
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City | LUMBERTON
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State | NC
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Zip | 28358-2355
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Country | US
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Telephone | 910-536-1719
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Fax | 910-668-8048
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Provider Business Mailing Address
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Address Line | 4904 FAYETTEVILLE RD STE A
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City | LUMBERTON
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State | NC
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Zip | 28358-2146
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Country | US
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Telephone | 910-536-1719
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Fax | 910-668-8048
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Authorized Official
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Title or Position | OWNER
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Name | MS. DEANA HOLLAND FLYNN
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Credential | PMHNP-BC
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Telephone | 910-536-1719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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