Organization
DAVID FORMWALT, PSY.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID J FORMWALT PSY.D. (CLINICAL PSYCHOLOGIST)
(251) 776-1217
Entity
Organization
Contact information
Practice address
7305 COTTAGE HILL RD, MOBILE, AL 36695-2829
(251) 776-1217
(251) 776-1219
Mailing address
PO BOX 91276, MOBILE, AL 36691-1276
(251) 776-1217
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1104
AL
Other
Enumeration date
05/05/2008
Last updated
05/05/2008
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