Provider Demographics
NPI:1992371140
Name:FORTUNE, CELESTE (LMSW)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:
Other - Last Name:POTTER-ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:6549 TOWN CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4824
Mailing Address - Country:US
Mailing Address - Phone:800-395-3223
Mailing Address - Fax:833-329-6632
Practice Address - Street 1:2401 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-9800
Practice Address - Country:US
Practice Address - Phone:800-395-3223
Practice Address - Fax:833-329-6632
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011100061041C0700X
MI68011170851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical