Healthcare Provider Details

I. General information

NPI: 1205740479
Provider Name (Legal Business Name): HEALING FORWARD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9323 KILBRIDE CT
PERRY HALL MD
21128-9329
US

IV. Provider business mailing address

9323 KILBRIDE CT
PERRY HALL MD
21128-9329
US

V. Phone/Fax

Practice location:
  • Phone: 410-698-5607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHANNELL FORTT
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCSW-C
Phone: 410-698-5607