Provider Demographics
NPI:1255605358
Name:FORTUNY, JENNIFER SUZANNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:FORTUNY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:SUZANNE
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCA
Mailing Address - Street 1:1665 GLENGARRY DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5771
Mailing Address - Country:US
Mailing Address - Phone:919-987-7880
Mailing Address - Fax:
Practice Address - Street 1:908 W MORGAN ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1512
Practice Address - Country:US
Practice Address - Phone:919-832-7866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172101YP2500X
NCA14116101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty