Provider Demographics
NPI:1891462735
Name:RICHARDSON, KAROLA DELLEMANN (MA, LCMHC-A, NCC)
Entity Type:Individual
Prefix:
First Name:KAROLA
Middle Name:DELLEMANN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MA, LCMHC-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:2106 LENNOXSHIRE SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-9457
Mailing Address - Country:US
Mailing Address - Phone:803-847-3143
Mailing Address - Fax:
Practice Address - Street 1:20901 TORRENCE CHAPEL RD STE 102B
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6397
Practice Address - Country:US
Practice Address - Phone:704-659-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16924101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health