Provider Demographics
NPI:1730917048
Name:WOMACK, STEPHANIE JOY (LMHCA)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:JOY
Last Name:WOMACK
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12203 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-9504
Mailing Address - Country:US
Mailing Address - Phone:209-277-4162
Mailing Address - Fax:
Practice Address - Street 1:654 OFFICERS ROW
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3836
Practice Address - Country:US
Practice Address - Phone:360-904-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61536296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health