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General NPI Number Information
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NPI Number | 1023432788
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Entity Type | Organization
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Legal Business Name | WOMACK COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 02/14/2014
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 503 POTOSI ST
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City | FARMINGTON
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State | MO
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Zip | 63640-3218
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Country | US
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Telephone | 573-756-1602
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Fax | 573-756-1603
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Provider Business Mailing Address
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Address Line | 503 POTOSI ST
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City | FARMINGTON
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State | MO
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Zip | 63640-3218
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Country | US
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Telephone | 573-756-1602
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Fax | 573-756-1603
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JAMES P WOMACK
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Credential | LCSW
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Telephone | 573-915-7986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 002712
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License Number State | MO
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