Provider Demographics
NPI:1174002901
Name:WOMBLE, TARA B (LCSW, LCDC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:B
Last Name:WOMBLE
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28496 RANCH ROAD 12 STE 200
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-5622
Mailing Address - Country:US
Mailing Address - Phone:254-498-8104
Mailing Address - Fax:
Practice Address - Street 1:28496 RANCH ROAD 12 STE 200
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-5622
Practice Address - Country:US
Practice Address - Phone:254-498-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58109104100000X
TX12655101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)