Provider Demographics
NPI:1235345794
Name:WOMACK, CYNTHIA GOODWIN (DHS, MNLMFT,CNS/PMH)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:GOODWIN
Last Name:WOMACK
Suffix:
Gender:F
Credentials:DHS, MNLMFT,CNS/PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 LULLWATER LN
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-5639
Mailing Address - Country:US
Mailing Address - Phone:404-261-7902
Mailing Address - Fax:706-485-5905
Practice Address - Street 1:1024 FOUNDERS ROW
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-5260
Practice Address - Country:US
Practice Address - Phone:404-261-7902
Practice Address - Fax:404-841-9296
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA626106H00000X
GAR027373364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health