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General NPI Number Information
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NPI Number | 1801028758
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Entity Type | Individual
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Provider Name | GRACE BROWN WOMACK
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Gender | Female
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Dates
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Enumeration Date | 08/11/2009
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Last Update Date | 11/19/2016
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Provider Practice Location Address
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Address Line | 2521 N GRAND AVE STE B
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City | SANTA ANA
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State | CA
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Zip | 92705-8725
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Country | US
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Telephone | 714-532-2526
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 PONDEROSA ST APT 6B
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City | SANTA ANA
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State | CA
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Zip | 92705-7945
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Country | US
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Telephone | 714-412-8976
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Fax |
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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 | ASW 32267
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License Number State | CA
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