Provider Demographics
NPI:1770373961
Name:WOMACK, REBECCA GRACE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:GRACE
Last Name:WOMACK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:GRACE
Other - Last Name:ROPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 MATTHEW LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-1548
Mailing Address - Country:US
Mailing Address - Phone:615-538-7281
Mailing Address - Fax:
Practice Address - Street 1:2729 BRANSFORD AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3131
Practice Address - Country:US
Practice Address - Phone:615-538-7281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health