Provider Demographics
NPI:1437403326
Name:RICHARDSON, SAMUEL III (DCC, LCPC, CTC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:RICHARDSON
Suffix:III
Gender:M
Credentials:DCC, LCPC, CTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-2707
Mailing Address - Country:US
Mailing Address - Phone:843-337-1979
Mailing Address - Fax:843-537-1479
Practice Address - Street 1:92 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-3414
Practice Address - Country:US
Practice Address - Phone:843-337-1979
Practice Address - Fax:843-537-1479
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE15461101YM0800X, 101YP1600X
FL15461101YM0800X, 101YP1600X, 106H00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist