Active NPI
Nicole R. Formwalt, LPC
- Professional Counselor
- Mobile, AL
National Provider Identifier
1255675146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2227
- Practice address
- 7305 Cottage Hill Rd
Mobile, AL 36695-2829 - Phone
- (251) 422-2043
- NPI assigned
- Nov 16, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2227 | AL | Primary |
Addresses
Primary practice location
7305 Cottage Hill Rd
Mobile, AL 36695-2829
Mailing address
54 Glenwood St
Mobile, AL 36606-1905
Phone (251) 476-7148
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353024000000",
"number": "1255675146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "54 GLENWOOD ST",
"city": "MOBILE",
"state": "AL",
"postal_code": "366061905",
"telephone_number": "251-476-7148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7305 COTTAGE HILL RD",
"city": "MOBILE",
"state": "AL",
"postal_code": "366952829",
"telephone_number": "251-422-2043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORMWALT",
"first_name": "NICOLE",
"middle_name": "R.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-11-16",
"last_updated": "2012-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AL",
"license": "2227",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mobile, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.