Provider Demographics
NPI:1578278230
Name:FORGIVENESS THERAPY, LLC
Entity Type:Organization
Organization Name:FORGIVENESS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:BASHLER
Authorized Official - Last Name:DORIVAL
Authorized Official - Suffix:
Authorized Official - Credentials:LGPC
Authorized Official - Phone:240-565-1544
Mailing Address - Street 1:208 FRESHET LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2168
Mailing Address - Country:US
Mailing Address - Phone:202-913-2713
Mailing Address - Fax:
Practice Address - Street 1:208 FRESHET LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2168
Practice Address - Country:US
Practice Address - Phone:202-913-2713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty