MEDICARE: VANESSA L WOMACK LPCC-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	E1700113	OH

General Provider Information

NPI Number	:	1184148306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA L WOMACK LPCC-S

Provider Business Mailing Address
First Line	:	1417 E 263RD ST
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-2917
Country	:	US
Telephone Number	:	216-798-7659
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N CLEVELAND MASSILLON RD STE 104
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-2484
Country	:	US
Telephone Number	:	216-798-7659
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2017
Last Update Date	:	04/16/2024

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