Provider Demographics
NPI:1063120483
Name:FORTUNE, ZAKIYA
Entity type:Individual
Prefix:
First Name:ZAKIYA
Middle Name:
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9659 N SAM HOUSTON PKWY E STE. 150, #108
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396
Mailing Address - Country:US
Mailing Address - Phone:346-329-3417
Mailing Address - Fax:
Practice Address - Street 1:20730 FOX HOUND LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-1460
Practice Address - Country:US
Practice Address - Phone:346-329-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX567321041C0700X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical