Healthcare Provider Details

I. General information

NPI: 1437640893
Provider Name (Legal Business Name): ANNA JILL WOMACK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MADISON AVE RM 806
NEW YORK NY
10017-5432
US

IV. Provider business mailing address

202 LIGHTHOUSE WAY
CARY NC
27511-7209
US

V. Phone/Fax

Practice location:
  • Phone: 646-863-4225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number022569
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6495
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6495
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: