Provider Demographics
NPI:1710036504
Name:RICHARDSON, CLARISSA MCRAE
Entity Type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:MCRAE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CLARISSA
Other - Middle Name:MCRAE
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:398 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5196
Mailing Address - Country:US
Mailing Address - Phone:828-331-9683
Mailing Address - Fax:828-586-5450
Practice Address - Street 1:398 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5196
Practice Address - Country:US
Practice Address - Phone:828-331-9683
Practice Address - Fax:828-586-5450
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor