Provider Demographics
NPI:1760982904
Name:WOMACKE, GIOVANNA (MA COUNSELING)
Entity Type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:
Last Name:WOMACKE
Suffix:
Gender:F
Credentials:MA COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8106 E JEFFERSON AVE APT D111
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-8052
Mailing Address - Country:US
Mailing Address - Phone:313-409-6105
Mailing Address - Fax:
Practice Address - Street 1:8106 E JEFFERSON AVE APT D111
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-8052
Practice Address - Country:US
Practice Address - Phone:313-409-6105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI6451023474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)