1821460619 NPI number — MRS. DONNA JANE WOMACK-MILLER MSW, LCSW

Table of content: MRS. DONNA JANE WOMACK-MILLER MSW, LCSW (NPI 1821460619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821460619 NPI number — MRS. DONNA JANE WOMACK-MILLER MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOMACK-MILLER
Provider First Name:
DONNA
Provider Middle Name:
JANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821460619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1023 FAIRFIELD CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAEFORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28376-6607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-550-3803
Provider Business Mailing Address Fax Number:
407-479-3846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
803 STAMPER RD STE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28303-4193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-223-7114
Provider Business Practice Location Address Fax Number:
910-550-3803
Provider Enumeration Date:
10/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C006107 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1821460619 . This is a "COMPSYCH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1821460619 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1821460619 . This is a "UNITED BEHAVIORAL HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1821460619 . This is a "SANDHILLS CENTER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1821460619 . This is a "FIRST CAROLINA CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1821460619 . This is a "MULTIPLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1821460619 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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