Provider Demographics
NPI:1275307480
Name:RICHARDSON, HEIDI LYNN (LCMHCA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 MCKENZIE PL
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-5002
Mailing Address - Country:US
Mailing Address - Phone:309-297-9941
Mailing Address - Fax:
Practice Address - Street 1:313 MCKENZIE PL
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460-5002
Practice Address - Country:US
Practice Address - Phone:309-297-9941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19559101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health