Provider Demographics
NPI:1497010011
Name:RICHARDSON, CARRIE (LCSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:RICHARDSON
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 1:950 STATE FARM RD BLDG 2ND
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5021
Mailing Address - Country:US
Mailing Address - Phone:828-268-9454
Mailing Address - Fax:828-268-9458
Practice Address - Street 1:950 STATE FARM RD BLDG 2ND
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5021
Practice Address - Country:US
Practice Address - Phone:828-268-9454
Practice Address - Fax:828-268-9458
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0093901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical