Provider Demographics
NPI:1851632335
Name:RICHARDSON, DEBRA ELAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ELAINE
Last Name:RICHARDSON
Suffix:
Gender:F
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:PO BOX 13352
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-3352
Mailing Address - Country:US
Mailing Address - Phone:626-646-6520
Mailing Address - Fax:
Practice Address - Street 1:CALIFORNIA MENS COLONY D QUAD
Practice Address - Street 2:HIGHWAY ONE
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93409-0001
Practice Address - Country:US
Practice Address - Phone:805-547-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 152901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical