Provider Demographics
NPI:1356954168
Name:FORTNER, ZULMA KARINA
Entity type:Individual
Prefix:
First Name:ZULMA
Middle Name:KARINA
Last Name:FORTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 MYRA RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7035
Mailing Address - Country:US
Mailing Address - Phone:909-489-9137
Mailing Address - Fax:
Practice Address - Street 1:2212 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4228
Practice Address - Country:US
Practice Address - Phone:910-779-0454
Practice Address - Fax:910-491-0833
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0151161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical