MEDICARE: DR. JAMES ERNEST FORRESTER EDD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701000588	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0701000588	OTHER	VA	BOARD OF COUNSELING

General Provider Information

NPI Number	:	1609019967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ERNEST FORRESTER EDD

Provider Business Mailing Address
First Line	:	4417 CORPORATION LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3162
Country	:	US
Telephone Number	:	757-552-7179
Fax Number	:	757-552-7508

Provider Business Practice Location Address
First Line	:	4417 CORPORATION LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3162
Country	:	US
Telephone Number	:	757-552-7179
Fax Number	:	757-552-7508

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2009
Last Update Date	:	04/15/2009

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