{
"Npi": {
"NPI": "1689061228",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WOMACK",
"FirstName": "TAMECKA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1282 SMALLWOOD DR W # 152",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WALDORF",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20603-4732",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "240-441-8524",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8200 PROFESSIONAL PLACE",
"SecondLinePracticeLocationAddress": "SUITE 104",
"PracticeLocationAddressCityName": "LANDOVER",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20785",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "240-441-8524",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/21/2015",
"LastUpdateDate": "03/18/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "LC7739",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "LGP5590",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}