Provider Demographics
NPI:1225623820
Name:RICHMOND, ANDREA (LMSWA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:LMSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NANNIE LN
Mailing Address - Street 2:
Mailing Address - City:STELLA
Mailing Address - State:NC
Mailing Address - Zip Code:28582-9663
Mailing Address - Country:US
Mailing Address - Phone:910-381-3858
Mailing Address - Fax:
Practice Address - Street 1:2407 GRACE AVE
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-4416
Practice Address - Country:US
Practice Address - Phone:252-514-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0157951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical