Provider Demographics
NPI:1740546225
Name:FORTNER-EDRIS, JOY JENNIFER (LPC, LMFT, CACP)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:JENNIFER
Last Name:FORTNER-EDRIS
Suffix:
Gender:F
Credentials:LPC, LMFT, CACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 RILEY SMITH DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615
Mailing Address - Country:US
Mailing Address - Phone:864-297-5101
Mailing Address - Fax:864-297-5423
Practice Address - Street 1:185 RILEY SMITH DRIVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-297-5101
Practice Address - Fax:864-297-5423
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5473101YA0400X
SC5267101YA0400X
SC5482101YP2500X
SC4599106H00000X
SC103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)