Provider Demographics
NPI:1184679219
Name:RICHARDS, RITA RENAE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:RENAE
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 1:1330 5TH ST NE
Mailing Address - Street 2:#135
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-2044
Mailing Address - Country:US
Mailing Address - Phone:704-538-0958
Mailing Address - Fax:704-538-3944
Practice Address - Street 1:215 SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:NC
Practice Address - Zip Code:28090-8254
Practice Address - Country:US
Practice Address - Phone:704-538-0958
Practice Address - Fax:704-538-3944
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0039431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC130T7OtherBCBS
NC6002270Medicaid
NC2874254BMedicare ID - Type Unspecified