Provider Demographics
NPI:1124356035
Name:MORGAN, RICHARD SAMUEL (MA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:SAMUEL
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4834 MACCORKLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1340
Mailing Address - Country:US
Mailing Address - Phone:304-346-9586
Mailing Address - Fax:303-344-2169
Practice Address - Street 1:4834 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1340
Practice Address - Country:US
Practice Address - Phone:304-346-9586
Practice Address - Fax:303-344-2169
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV989103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical