Provider Demographics
NPI:1699835348
Name:WOMACK, ROSELYN DENISE (MS, MFTI)
Entity Type:Individual
Prefix:MS
First Name:ROSELYN
Middle Name:DENISE
Last Name:WOMACK
Suffix:
Gender:F
Credentials:MS, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-2535
Mailing Address - Country:US
Mailing Address - Phone:415-392-4453
Mailing Address - Fax:415-433-0953
Practice Address - Street 1:720 SACRAMENTO STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108
Practice Address - Country:US
Practice Address - Phone:415-392-4453
Practice Address - Fax:415-433-0953
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67894101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist