Provider Demographics
NPI:1740034545
Name:WOMACK, LISA CORLETTA (LCSWA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CORLETTA
Last Name:WOMACK
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONG SHOALS RD APT 3G
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-7718
Mailing Address - Country:US
Mailing Address - Phone:919-736-3394
Mailing Address - Fax:
Practice Address - Street 1:300 LONG SHOALS RD APT 3G
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7718
Practice Address - Country:US
Practice Address - Phone:919-736-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0202341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical