Active NPI
Tony Joe Fortin, LCMHCS, LCAS, CCS
- Mental Health Counselor
- Greensboro, NC
National Provider Identifier
1689742462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2999
- Practice address
- 1203 Maple St
Greensboro, NC 27405-6910 - Phone
- (336) 641-3934
- Fax
- (336) 641-6193
- NPI assigned
- Dec 1, 2006
- Last updated
- Dec 30, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 692 | NC | |
| Mental Health Counselor | 101YM0800X | 2999 | NC | Primary |
| Professional Counselor | 101YP2500X | 2999 | NC |
Addresses
Primary practice location
1203 Maple St
Greensboro, NC 27405-6910
Mailing address
1203 Maple St
Greensboro, NC 27405-6910
Phone (336) 641-3934
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6102795 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 692 | NC | MD | Professional Counselor |
| 2999 | NC | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640822400000",
"number": "1689742462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1203 MAPLE ST",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274056910",
"telephone_number": "336-641-3934",
"fax_number": "336-641-6193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1203 MAPLE ST",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274056910",
"telephone_number": "336-641-3934",
"fax_number": "336-641-6193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTIN",
"first_name": "TONY",
"middle_name": "JOE",
"credential": "LCMHCS, LCAS, CCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-01",
"last_updated": "2021-12-30",
"certification_date": "2021-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "692",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "2999",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "2999",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6102795",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.