Provider Demographics
NPI:1922377373
Name:WOMACK, TRICIA W (MS)
Entity Type:Individual
Prefix:MS
First Name:TRICIA
Middle Name:W
Last Name:WOMACK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:TRICIA
Other - Middle Name:D
Other - Last Name:WIEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2409 HOMER CLAYTON DR
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-2207
Mailing Address - Country:US
Mailing Address - Phone:256-582-3203
Mailing Address - Fax:256-582-4161
Practice Address - Street 1:2409 HOMER CLAYTON DR
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-2207
Practice Address - Country:US
Practice Address - Phone:256-582-3203
Practice Address - Fax:256-582-4161
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health