Provider Demographics
NPI:1477298172
Name:SUZANNE FORTNUM CONSULTING LLC
Entity Type:Organization
Organization Name:SUZANNE FORTNUM CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTNUM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC MA
Authorized Official - Phone:202-870-4130
Mailing Address - Street 1:7803 SUTTER LN
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4974
Mailing Address - Country:US
Mailing Address - Phone:202-870-4130
Mailing Address - Fax:
Practice Address - Street 1:600 CAMERON ST STE 113
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2506
Practice Address - Country:US
Practice Address - Phone:202-870-4130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUZANNE FORTNUM CONSULTING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1396358974OtherCOMMERCIAL INSURANCE