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General NPI Number Information
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NPI Number | 1053981605
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Entity Type | Organization
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Legal Business Name | FORWARD THERAPEUTICS LLC
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Dates
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Enumeration Date | 06/27/2021
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 118 W 1ST ST STE 308
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City | DAYTON
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State | OH
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Zip | 45402-1150
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Country | US
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Telephone | 937-443-7659
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Fax | 855-978-1771
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Provider Business Mailing Address
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Address Line | 118 W 1ST ST STE 308
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City | DAYTON
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State | OH
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Zip | 45402-1150
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Country | US
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Telephone | 937-443-7659
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Fax | 855-978-1771
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Authorized Official
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Title or Position | OWNER
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Name | CHUCKEIA FOLLEY
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Credential | LPCC-S
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Telephone | 937-367-4614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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