Provider Demographics
NPI:1245958115
Name:RICHARDSON, DAN DWAN (MSW)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:DWAN
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MSW
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 6134
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32314-6134
Mailing Address - Country:US
Mailing Address - Phone:850-294-2702
Mailing Address - Fax:
Practice Address - Street 1:1367 E LAFAYETTE ST STE C
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4769
Practice Address - Country:US
Practice Address - Phone:850-536-6632
Practice Address - Fax:888-462-8914
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW17166104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty