Provider Demographics
NPI:1083010367
Name:RICHARDS, SANDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 S FLORIDA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2512
Mailing Address - Country:US
Mailing Address - Phone:863-860-0531
Mailing Address - Fax:863-510-5903
Practice Address - Street 1:5110 S FLORIDA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2512
Practice Address - Country:US
Practice Address - Phone:863-860-0531
Practice Address - Fax:863-510-5903
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 123011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical