Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | PIP268-1020C | AL |
NPI | 1003005216 |
---|---|
Provider Name | Ms. Kimberley J Womack |
First Address | Gadsden, AL 35904-3254 |
Second Address | Gadsden, AL 35903-1106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2007 |
Last Update Date | 24/10/2007 |