Individual provider · Type 1 NPI
Dominique Forsman
Mental Health Counselor · Churchton, MD
NPI number
1972321180
Active
Practice location
5419 Deale Churchton Rd Ste 104
Churchton, MD 20733-2408
Mailing address
1613 Virginia St
Annapolis, MD 21401-4029
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor | 101Y00000X | LC18571 (MD) |
| Mental Health Counselor Primary | 101YM0800X | LC18571 (MD) |
Mental Health Counselor: Definition to come...
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About NPI 1972321180
Dominique Forsman's National Provider Identifier is 1972321180, issued on Sep 27, 2024. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Churchton, MD. The record was last updated on Sep 24, 2026.