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NPI Code Detail

MEDICARE: MRS. ERIN SUZANNE FORTUNA GCDF, LPC

MEDICARE: MRS. ERIN SUZANNE FORTUNA GCDF, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor6401010920MI

General Provider Information

NPI Number : 1093074734
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ERIN SUZANNE FORTUNA GCDF, LPC
Provider Business Mailing Address
First Line : 60 HUBBARD ST
Second Line :
City : MOUNT CLEMENS
State : MI
Zip : 48043-5517
Country : US
Telephone Number : 586-909-1798
Fax Number :
Provider Business Practice Location Address
First Line : 9844 DIXIE HWY
Second Line :
City : IRA
State : MI
Zip : 48023-2813
Country : US
Telephone Number : 586-716-7600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2012
Last Update Date : 05/15/2012

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