MEDICARE: FORTIFIED COUNSELING AND CONSULTING, LLC

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
1	1041C0700X	Clinical Social Worker	LC303590	DC

General Provider Information

NPI Number	:	1255840138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORTIFIED COUNSELING AND CONSULTING, LLC

Provider Business Mailing Address
First Line	:	1200 G ST NW STE 800
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20005-6705
Country	:	US
Telephone Number	:	202-854-9628
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 G ST NW STE 800
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20005-6705
Country	:	US
Telephone Number	:	202-854-9628
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL ADMINISTRATOR
Name	:	MS. ORISIA WALLACE
Credential	:	MSW LICSW
Telephone Number	:	202-854-9628

Provider Enumeration Date	:	09/23/2017
Last Update Date	:	07/21/2022

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