Provider Demographics
NPI:1295289411
Name:WOMACK, ANNA LANE (LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:LANE
Last Name:WOMACK
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RIVER VISTA DR
Mailing Address - Street 2:#634
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-7602
Mailing Address - Country:US
Mailing Address - Phone:404-316-6495
Mailing Address - Fax:
Practice Address - Street 1:2759 DELK RD SE
Practice Address - Street 2:SUITE 1200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8847
Practice Address - Country:US
Practice Address - Phone:678-401-4596
Practice Address - Fax:678-401-3126
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008735101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional