Provider Demographics
NPI:1528571098
Name:RICHARDSON, CARDIA MONIQUE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CARDIA
Middle Name:MONIQUE
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 1:1430 WILLOW PASS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-7946
Mailing Address - Country:US
Mailing Address - Phone:925-288-3916
Mailing Address - Fax:925-646-5774
Practice Address - Street 1:1430 WILLOW PASS RD STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-7946
Practice Address - Country:US
Practice Address - Phone:925-288-3916
Practice Address - Fax:925-646-5774
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW74103251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty