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General NPI Number Information
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NPI Number | 1053976381
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Entity Type | Individual
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Provider Name | CAROLYN D WOMACK LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 800 OHIO AVE
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City | CLARKSDALE
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State | MS
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Zip | 38614-7200
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Country | US
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Telephone | 662-624-2504
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Fax | 662-627-3629
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Provider Business Mailing Address
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Address Line | PO BOX 1216
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City | CLARKSDALE
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State | MS
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Zip | 38614-1216
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Country | US
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Telephone | 662-624-4292
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Fax | 662-624-4354
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | C6051
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License Number State | MS
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