Provider Demographics
NPI:1962624650
Name:WOMACK, ANN J (PHD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:J
Last Name:WOMACK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 LONESOME MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-6010
Mailing Address - Country:US
Mailing Address - Phone:434-825-4001
Mailing Address - Fax:
Practice Address - Street 1:3134 LONESOME MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-6010
Practice Address - Country:US
Practice Address - Phone:434-825-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002087103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical