Provider Demographics
NPI:1689764409
Name:RICHEY, WILMA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WILMA
Middle Name:J
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 1:4432 NW 23RD AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6599
Mailing Address - Country:US
Mailing Address - Phone:352-380-0992
Mailing Address - Fax:352-373-2221
Practice Address - Street 1:4432 NW 23RD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6599
Practice Address - Country:US
Practice Address - Phone:352-380-0992
Practice Address - Fax:352-373-2221
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW20161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4242Medicare ID - Type Unspecified