Provider Demographics
NPI:1851880629
Name:RICHARDSON, ZEONDRA EVONNE (LICSW)
Entity Type:Individual
Prefix:
First Name:ZEONDRA
Middle Name:EVONNE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LICSW
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 28578
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-8578
Mailing Address - Country:US
Mailing Address - Phone:206-271-8492
Mailing Address - Fax:
Practice Address - Street 1:8811 36TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-4801
Practice Address - Country:US
Practice Address - Phone:206-271-8492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW608195341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty