Individual
DAVID FORMWALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY D
Contact information
Practice address
7305 COTTAGE HILL ROAD, MOBILE, AL 36695
(251) 776-1217
(251) 776-1219
Mailing address
POB 91276, DAVID FORMWALT PSY D LLC, MOBILE, AL 36691
(251) 776-1217
(251) 776-1219
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1104
AL
Other
Enumeration date
11/07/2006
Last updated
07/09/2007
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