Provider Demographics
NPI:1265005227
Name:WOMACK, ABBY (TLMHC)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:WOMACK
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 DES MOINES AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-4444
Mailing Address - Country:US
Mailing Address - Phone:319-209-2084
Mailing Address - Fax:319-209-2086
Practice Address - Street 1:2115 DES MOINES AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-4444
Practice Address - Country:US
Practice Address - Phone:319-209-2084
Practice Address - Fax:319-209-2086
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health