Provider Demographics
NPI:1487973871
Name:WOMACK, TODD ANDRE (LMSW)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:ANDRE
Last Name:WOMACK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 CHALMERS ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2264
Mailing Address - Country:US
Mailing Address - Phone:810-287-0413
Mailing Address - Fax:
Practice Address - Street 1:422 CHALMERS ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2264
Practice Address - Country:US
Practice Address - Phone:810-287-0413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010730521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical