Provider Demographics
NPI:1013065333
Name:RICHARDSON, ADDISON RONALD (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ADDISON
Middle Name:RONALD
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SANDPINE CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7655
Mailing Address - Country:US
Mailing Address - Phone:803-788-9455
Mailing Address - Fax:803-896-9588
Practice Address - Street 1:5000 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3532
Practice Address - Country:US
Practice Address - Phone:803-896-9421
Practice Address - Fax:803-896-9588
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0069381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical