Provider Demographics
NPI:1407571599
Name:FORTIS BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:FORTIS BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:910-536-1719
Mailing Address - Street 1:220 WINTERGREEN DR STE B
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2188
Mailing Address - Country:US
Mailing Address - Phone:910-536-1719
Mailing Address - Fax:910-536-1717
Practice Address - Street 1:220 WINTERGREEN DR STE B
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2188
Practice Address - Country:US
Practice Address - Phone:910-536-1719
Practice Address - Fax:910-536-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty