Provider Demographics
NPI:1760756928
Name:FORTUNE, ANNA (LPC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 DUG GAP RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-5007
Mailing Address - Country:US
Mailing Address - Phone:770-317-0259
Mailing Address - Fax:
Practice Address - Street 1:2035 CULBRETH CIR
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:AL
Practice Address - Zip Code:35094-3632
Practice Address - Country:US
Practice Address - Phone:770-317-0259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC003110101YM0800X
GALPC007489101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health