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General NPI Number Information
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NPI Number | 1861160715
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Entity Type | Individual
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Provider Name | ERICA SHONTA WOMACK LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 1640 POWERS FERRY RD SE BLDG 14-200
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City | MARIETTA
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State | GA
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Zip | 30067-1459
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Country | US
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Telephone | 770-342-8072
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Fax |
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Provider Business Mailing Address
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Address Line | 76 TWELVE OAKS DR SE
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City | CARTERSVILLE
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State | GA
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Zip | 30120-5801
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Country | US
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Telephone | 404-360-2060
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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 | MSW010107
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License Number State | GA
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