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General NPI Number Information
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NPI Number | 1174033302
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Entity Type | Individual
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Provider Name | GEORGE MICHAEL FORSYTHE LGPC
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Gender | Male
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 2028 LIBERTY RD STE 202
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City | ELDERSBURG
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State | MD
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Zip | 21784-6980
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Country | US
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Telephone | 443-615-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 2028 LIBERTY RD STE 202
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City | ELDERSBURG
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State | MD
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Zip | 21784-6980
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Country | US
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Telephone | 443-615-2727
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LGP11021
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC13367
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License Number State | MD
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