Provider Demographics
NPI:1861725780
Name:WOMACK, ALLISON JAYNE (MA)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:JAYNE
Last Name:WOMACK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:ALLISON
Other - Middle Name:JAYNE
Other - Last Name:MORLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1914 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-7008
Mailing Address - Country:US
Mailing Address - Phone:916-869-2932
Mailing Address - Fax:
Practice Address - Street 1:2555 3RD ST
Practice Address - Street 2:SUITE 108
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-1100
Practice Address - Country:US
Practice Address - Phone:916-443-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954778179OtherEIN