Provider Demographics
NPI:1760163695
Name:RICHARDSON, AMY LAWSON (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LAWSON
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:400 FLEMINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WACCAMAW
Mailing Address - State:NC
Mailing Address - Zip Code:28450
Mailing Address - Country:US
Mailing Address - Phone:910-646-3083
Mailing Address - Fax:
Practice Address - Street 1:104 E OLD HIGHWAY 74 76
Practice Address - Street 2:
Practice Address - City:LAKE WACCAMAW
Practice Address - State:NC
Practice Address - Zip Code:28450-2512
Practice Address - Country:US
Practice Address - Phone:910-646-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0120661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical