| Dominique Forsman, | |
|
5419 Deale Churchton Rd Ste 104, Churchton, MD 20733-2408 | |
| (410) 541-6686 | |
| Not Available |
| Full Name | Dominique Forsman |
|---|---|
| Gender | Female |
| Speciality | Counselor - Mental Health |
| Location | 5419 Deale Churchton Rd Ste 104, Churchton, Maryland |
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972321180 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | LGP15666 (Maryland) | Secondary |
| 101YM0800X | Counselor - Mental Health | LGP15666 (Maryland) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Dominique Forsman, 1613 Virginia St, Annapolis, MD 21401-4029 Ph: (240) 291-1436 | Dominique Forsman, 5419 Deale Churchton Rd Ste 104, Churchton, MD 20733-2408 Ph: (410) 541-6686 |
Lindsey O'donnell, LGPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 5419 Deale Churchton Rd Ste 104, Churchton, MD 20733 Phone: 410-541-6686 | |
Ashley Oursler, LGPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 5419 Deale Churchton Rd Ste 104, Churchton, MD 20733 Phone: 410-541-6686 | |
Christina Johnson, LCPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 5532 Dartmouth St, Churchton, MD 20733 Phone: 410-980-4171 | |
Lizatte Martin, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1228 Garret Ave, Churchton, MD 20733 Phone: 667-200-6006 | |
Mr. Raleigh L Burch Jr., Counselor Medicare: Medicare Enrolled Practice Location: 5419 Deale Churchton Rd, Suite 102, Churchton, MD 20733 Phone: 443-607-6207 Fax: 443-607-6208 |