Provider Demographics
NPI:1457719148
Name:RICHARDSON, STEPHANIE (MS, LCHMC, LCAS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MS, LCHMC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 S ASHEBORO ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:27298-7503
Mailing Address - Country:US
Mailing Address - Phone:727-439-8276
Mailing Address - Fax:
Practice Address - Street 1:5509B W FRIENDLY AVE STE 105
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4249
Practice Address - Country:US
Practice Address - Phone:336-687-9826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12076101YM0800X
NCLCAS-22714101YA0400X
NC12076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)