Healthcare Provider Details

I. General information

NPI: 1891478715
Provider Name (Legal Business Name): MOVING FORWARD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 W 25TH ST STE 206
BALTIMORE MD
21218-5002
US

IV. Provider business mailing address

16 W 25TH ST STE 206
BALTIMORE MD
21218-5002
US

V. Phone/Fax

Practice location:
  • Phone: 443-415-7379
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LASHAN DOUGLASS
Title or Position: CEO
Credential:
Phone: 443-415-7379