Provider Demographics
NPI:1184338154
Name:WOMACK, VICTORIA RENEE (MSW)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:RENEE
Last Name:WOMACK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 KENDALL TOWN BLVD UNIT 6303
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-7241
Mailing Address - Country:US
Mailing Address - Phone:757-912-2262
Mailing Address - Fax:
Practice Address - Street 1:6639 SOUTHPOINT PKWY STE 108
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8042
Practice Address - Country:US
Practice Address - Phone:757-912-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical