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Individual

CARLA MICHELLE FORTNEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200
Mailing address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
C.1400668
OH
101Y00000X
Counselor
Primary
E.2202853
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0280222
OH
Enumeration date
01/19/2018
Last updated
05/04/2022
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