Provider Demographics
NPI:1629831565
Name:FORTUIDE WELLBEING LLC
Entity Type:Organization
Organization Name:FORTUIDE WELLBEING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HIX
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-325-6935
Mailing Address - Street 1:3425 BAYSIDE LAKES BLVD SE STE 103-1184
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6867
Mailing Address - Country:US
Mailing Address - Phone:321-325-6935
Mailing Address - Fax:321-325-6840
Practice Address - Street 1:3425 BAYSIDE LAKES BLVD SE STE 103-1184
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6867
Practice Address - Country:US
Practice Address - Phone:321-325-6935
Practice Address - Fax:321-325-6840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)