Provider Demographics
NPI:1861160715
Name:WOMACK, ERICA SHONTA (LMSW)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:SHONTA
Last Name:WOMACK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:SHONTA
Other - Last Name:MCCASKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:76 TWELVE OAKS DR SE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-5801
Mailing Address - Country:US
Mailing Address - Phone:404-360-2060
Mailing Address - Fax:
Practice Address - Street 1:1640 POWERS FERRY RD SE BLDG 14-200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-1459
Practice Address - Country:US
Practice Address - Phone:770-342-8072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0101071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty