Provider Demographics
NPI:1538437678
Name:WOMACK, DAWN (LCSW)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:WOMACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:MICHAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2311 DARTMOUTH HILL CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3533
Mailing Address - Country:US
Mailing Address - Phone:225-252-8621
Mailing Address - Fax:225-427-8504
Practice Address - Street 1:2311 DARTMOUTH HILL CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3533
Practice Address - Country:US
Practice Address - Phone:225-290-8535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-04
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA96831041C0700X
TX1074121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600884183Medicaid