Healthcare Provider Details

I. General information

NPI: 1932031739
Provider Name (Legal Business Name): ALEXIS SKYE FORSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S BRIDGE ST
ELKTON MD
21921-5915
US

IV. Provider business mailing address

1538 SINGERLY RD
ELKTON MD
21921-4951
US

V. Phone/Fax

Practice location:
  • Phone: 410-505-0063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: