Individual
LAURA G FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
327 W 21ST ST, SUITE 205, NORFOLK, VA 23517-2130
(757) 622-9852
(757) 622-4033
Mailing address
327 W 21ST ST, SUITE 205, NORFOLK, VA 23517-2130
(757) 622-9852
(757) 622-4033
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810001083
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007734301
—
VA
Enumeration date
10/19/2006
Last updated
07/08/2007
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