Provider Demographics
NPI:1568993624
Name:RICHARDSON, CHARLOTTE RENEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:RENEE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CHARLOTTE
Other - Middle Name:RENEE
Other - Last Name:PASCHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1178 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6449
Mailing Address - Country:US
Mailing Address - Phone:707-344-4726
Mailing Address - Fax:
Practice Address - Street 1:1178 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6449
Practice Address - Country:US
Practice Address - Phone:707-344-4726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical