Formwalt, Annie L
Formwalt, Annie L is an individual health care provider with primary practice located at Po Box 850818 , Mobile AL 36685-0818. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Formwalt, Annie L can be contacted via phone (251) 776-1217.Contact Information
Primary practice address
Po Box 850818
Mobile AL 36685-0818
Phone: (251) 776-1217
Fax: (251) 776-1219
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 504 | Alabama |
Profile Details
| NPI number | 1861696759 |
|---|---|
| LBN Legal business name | Formwalt, Annie L |
| Credentials | PSY.D. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 13th, 2007 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861696759 | NPPES |
| Alabama | Other | 51071147 | BLUE CROSS AND BLUE SHIEL |
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