Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | TYPE A. 041732 & 266 | LA |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 266 | LA |
N | 101YM0800X | Mental Health Counselor | 266 | LA |
N | 101YP2500X | Professional Counselor | 266 | LA |
N | 101YS0200X | School Counselor | TYPE A. 041732 | LA |
NPI | 1215089990 |
---|---|
Provider Name | Mrs. Dildred Small Womack |
First Address | Greensburg, LA 70441-3675 |
Second Address | Greensburg, LA 70441-3657 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/02/2011 |