Provider Demographics
NPI:1114382819
Name:RICHARDSON, RENADA (MA, CACP-I)
Entity Type:Individual
Prefix:
First Name:RENADA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MA, CACP-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-1508
Mailing Address - Country:US
Mailing Address - Phone:803-635-2335
Mailing Address - Fax:803-635-9665
Practice Address - Street 1:200 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-1508
Practice Address - Country:US
Practice Address - Phone:803-635-2335
Practice Address - Fax:803-635-9665
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)