Provider Demographics
NPI:1346926193
Name:RICHARDSON, CHERL RENA (CSW)
Entity Type:Individual
Prefix:
First Name:CHERL
Middle Name:RENA
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8195 ILSLEY RD
Mailing Address - Street 2:
Mailing Address - City:DAWSON SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42408-9652
Mailing Address - Country:US
Mailing Address - Phone:127-087-1830
Mailing Address - Fax:
Practice Address - Street 1:111 SUSAN AVE
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4951
Practice Address - Country:US
Practice Address - Phone:270-962-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6715104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker