NPIMap

Organization Active NPI

Fortitude Wellness Collective, LLC

  • Clinical Social Worker
  • Alexandria, VA
National Provider Identifier
1063118776
Registry record updated Feb 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
FORTITUDE WELLNESS COLLECTIVE, LLC
Practice address
3922 Vermont Ave
Alexandria, VA 22304-6325
Phone
(202) 505-1916
NPI assigned
Feb 3, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rashonda Iesha Riley, LCSW, LICSWNPI 1174289706
Title
Clinical Social Worker
Phone
(228) 218-3593

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

3922 Vermont Ave
Alexandria, VA 22304-6325

Mailing address

712 H St NE Ste 1851
Washington, DC 20002-3627
Phone (202) 505-1916

National Provider Directory

National Provider Directory

Locations

712 H St NE
Ste 1851
Washington, DC 20002
Phone (202) 505-1916

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675555200000",
    "number": "1063118776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 H ST NE STE 1851",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200023627",
            "telephone_number": "202-505-1916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3922 VERMONT AVE",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223046325",
            "telephone_number": "202-505-1916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORTITUDE WELLNESS COLLECTIVE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-03",
        "last_updated": "2023-02-05",
        "certification_date": "2023-02-05",
        "status": "A",
        "authorized_official_last_name": "RILEY",
        "authorized_official_first_name": "RASHONDA",
        "authorized_official_middle_name": "IESHA",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "228-218-3593",
        "authorized_official_credential": "LCSW, LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.