Individual
DR. REBEKAH FORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1300 E MARSHALL ST, RICHMOND, VA 23298-5054
(804) 828-4231
Mailing address
3126 W CARY ST # 404, RICHMOND, VA 23221-3504
(804) 554-1760
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810005256
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZLF120196911
REGENCE BLUE SHIELD ID NUMBER
WA
Enumeration date
05/26/2013
Last updated
03/26/2018
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