Provider Demographics
NPI:1508481375
Name:RICHARDSON, ANDREA CHENISE (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:CHENISE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43602 S TIMBERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3354
Mailing Address - Country:US
Mailing Address - Phone:734-223-6827
Mailing Address - Fax:
Practice Address - Street 1:5900 YORK RD STE 203
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3040
Practice Address - Country:US
Practice Address - Phone:410-323-3236
Practice Address - Fax:410-323-3239
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD256021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical