Provider Demographics
NPI:1073114666
Name:RICHARDSON, AMANDA ELAINE (LCMHCA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ELAINE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 W GOLDENEYE LN
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-8096
Mailing Address - Country:US
Mailing Address - Phone:803-605-2876
Mailing Address - Fax:
Practice Address - Street 1:352 W GOLDENEYE LN
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460-8096
Practice Address - Country:US
Practice Address - Phone:803-605-2876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health