1841040094 NPI number — FORTIFIED MINDS & COURAGEOUS CONVERSATIONS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841040094 NPI number — FORTIFIED MINDS & COURAGEOUS CONVERSATIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORTIFIED MINDS & COURAGEOUS CONVERSATIONS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841040094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
704 AVENUE D STE 702
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OPELIKA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36801-4962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-603-0006
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
704 AVENUE D STE 702
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OPELIKA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36801-4962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-603-0006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2024

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
KAYCEE
Authorized Official Middle Name:
COLON
Authorized Official Title or Position:
LICENSED PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
334-603-0006

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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