Individual
NICOLE R. FORMWALT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
7305 COTTAGE HILL RD, MOBILE, AL 36695-2829
(251) 422-2043
Mailing address
54 GLENWOOD ST, MOBILE, AL 36606-1905
(251) 476-7148
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2227
AL
Other
Enumeration date
11/16/2012
Last updated
11/16/2012
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