Individual
CHANNELL FORTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
30435 MOUNT VERNON RD, PRINCESS ANNE, MD 21853-1437
(443) 754-2164
Mailing address
30435 MOUNT VERNON RD, PRINCESS ANNE, MD 21853-1437
(443) 754-2164
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
04/29/2022
Last updated
04/29/2022
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