Provider Demographics
NPI:1821460619
Name:WOMACK-MILLER, DONNA JANE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:JANE
Last Name:WOMACK-MILLER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 FAIRFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-6607
Mailing Address - Country:US
Mailing Address - Phone:910-550-3803
Mailing Address - Fax:407-479-3846
Practice Address - Street 1:803 STAMPER RD STE G
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4193
Practice Address - Country:US
Practice Address - Phone:910-223-7114
Practice Address - Fax:910-550-3803
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0061071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1821460619OtherCOMPSYCH
NC1821460619OtherBCBS
NC1821460619OtherUNITED BEHAVIORAL HEALTHCARE
NC1821460619OtherSANDHILLS CENTER
NC1821460619OtherFIRST CAROLINA CARE
NC1821460619OtherMULTIPLAN
NC1821460619Medicaid