Provider Demographics
NPI:1508202896
Name:RICHARDSON-LAUVE, JOHN AUSTNI (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:AUSTNI
Last Name:RICHARDSON-LAUVE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7020
Mailing Address - Country:US
Mailing Address - Phone:804-644-9590
Mailing Address - Fax:804-649-2151
Practice Address - Street 1:200 N 22ND ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7020
Practice Address - Country:US
Practice Address - Phone:804-644-9590
Practice Address - Fax:804-649-2151
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040081801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945182Medicaid