Provider Demographics
NPI:1639282254
Name:RICHEY, CHARLES R (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:RICHEY
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 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2227
Mailing Address - Country:US
Mailing Address - Phone:276-236-1699
Mailing Address - Fax:276-236-1715
Practice Address - Street 1:500 GLENDALE RD
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2208
Practice Address - Country:US
Practice Address - Phone:276-236-1699
Practice Address - Fax:276-236-1715
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040029181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI800011428OtherMEDICARE RAILROAD
VI521622OtherVALUE OPTIONS
VA004945298Medicaid
VA178387OtherANTHEM BLUE CROSS
VA80002707Medicare UPIN