Provider Demographics
NPI:1003519703
Name:FORTIFY ABA AND CONSULTING LLC
Entity Type:Organization
Organization Name:FORTIFY ABA AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:703-980-4720
Mailing Address - Street 1:6101 NOWAK CT APT C
Mailing Address - Street 2:
Mailing Address - City:FORT JOHNSON
Mailing Address - State:LA
Mailing Address - Zip Code:71459-3651
Mailing Address - Country:US
Mailing Address - Phone:703-980-4720
Mailing Address - Fax:
Practice Address - Street 1:6101 NOWAK CT APT C
Practice Address - Street 2:
Practice Address - City:FORT JOHNSON
Practice Address - State:LA
Practice Address - Zip Code:71459-3651
Practice Address - Country:US
Practice Address - Phone:703-980-4720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty