Provider Demographics
NPI:1780231878
Name:FORTITUDE PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:FORTITUDE PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH-SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPA
Authorized Official - Phone:910-620-8575
Mailing Address - Street 1:4900 RANDALL PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2831
Mailing Address - Country:US
Mailing Address - Phone:910-799-7557
Mailing Address - Fax:910-799-7558
Practice Address - Street 1:4900 RANDALL PKWY STE D
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2831
Practice Address - Country:US
Practice Address - Phone:910-799-7557
Practice Address - Fax:910-799-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)