Provider Demographics
NPI:1578728739
Name:RICHARDSON, TAKIA DESHON (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:TAKIA
Middle Name:DESHON
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 HARCOURT RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6145
Mailing Address - Country:US
Mailing Address - Phone:301-257-6895
Mailing Address - Fax:
Practice Address - Street 1:750 1ST ST NE STE 800
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-8011
Practice Address - Country:US
Practice Address - Phone:301-257-6895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-26
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500783171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical