Provider Demographics
NPI:1538943535
Name:FORTSON, DESHUNDRIA L (LCPC, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:DESHUNDRIA
Middle Name:L
Last Name:FORTSON
Suffix:
Gender:F
Credentials:LCPC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5557 BALTIMORE AVE STE 500-1032
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-1922
Mailing Address - Country:US
Mailing Address - Phone:202-656-9002
Mailing Address - Fax:
Practice Address - Street 1:5557 BALTIMORE AVE STE 500-1032
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-1922
Practice Address - Country:US
Practice Address - Phone:202-656-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC14289101Y00000X
DCPRC200001619101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor