Healthcare Provider Details

I. General information

NPI: 1497392989
Provider Name (Legal Business Name): FORWARD MOVING COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 BELLONA LN
TOWSON MD
21204-2055
US

IV. Provider business mailing address

3509 BRANCH COURT RD
PARKVILLE MD
21234-3410
US

V. Phone/Fax

Practice location:
  • Phone: 410-245-2611
  • Fax:
Mailing address:
  • Phone: 410-245-2611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. BOBBY VANN JR.
Title or Position: OWNER
Credential: LCPC
Phone: 410-245-2611