Provider Demographics
NPI:1588940662
Name:WOMACK, NADIA DOMINIQUE EDWARDS (BA)
Entity type:Individual
Prefix:MRS
First Name:NADIA
Middle Name:DOMINIQUE EDWARDS
Last Name:WOMACK
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 FALLS ROAD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2551
Mailing Address - Country:US
Mailing Address - Phone:410-366-1980
Mailing Address - Fax:410-366-8530
Practice Address - Street 1:4623 FALLS RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4914
Practice Address - Country:US
Practice Address - Phone:410-366-1980
Practice Address - Fax:410-366-8530
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health