Provider Demographics
NPI:1578293361
Name:FORWARD MOMENTUM THERAPEUTIC SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:FORWARD MOMENTUM THERAPEUTIC SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINA
Authorized Official - Middle Name:RASHID
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCS
Authorized Official - Phone:252-425-7527
Mailing Address - Street 1:2227 BAYSWATER DR
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-7837
Mailing Address - Country:US
Mailing Address - Phone:252-425-7527
Mailing Address - Fax:
Practice Address - Street 1:116 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-9747
Practice Address - Country:US
Practice Address - Phone:252-425-7527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1083048524Medicaid