Individual
MRS. CAROL G FORTUNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1522 GOLDEN RIDGE DR, LADY LAKE, FL 32162-6765
(352) 638-2264
(352) 259-4050
Mailing address
1522 GOLDEN RIDGE DR, LADY LAKE, FL 32162-6765
(352) 638-2264
(352) 259-4050
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
103065
MA
1041C0700X
Clinical Social Worker
Primary
SW8072
FL
Other
Enumeration date
08/30/2006
Last updated
07/08/2007
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