Provider Demographics
NPI:1487459525
Name:SOUTHERN MENTAL HEALTH WELLNESS & TRAUMA RECOVERY CENTER, LLC
Entity type:Organization
Organization Name:SOUTHERN MENTAL HEALTH WELLNESS & TRAUMA RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-252-8621
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 1:12320 HIGHWAY 44 STE 3D
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-2202
Practice Address - Country:US
Practice Address - Phone:225-252-8621
Practice Address - Fax:225-427-8504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAWN WOMACK LCSW, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty