Provider Demographics
NPI:1649246901
Name:RICHARDSON, KAREN ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ELIZABETH
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:ELIZABETH
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2720 LIBERTY RD NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-4745
Mailing Address - Country:US
Mailing Address - Phone:540-981-1102
Mailing Address - Fax:540-344-4169
Practice Address - Street 1:2720 LIBERTY RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-4745
Practice Address - Country:US
Practice Address - Phone:540-981-1102
Practice Address - Fax:540-344-4169
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040052011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA087375MOtherSENTARA
VA250241OtherMAMSI/UNITED HEALTHCARE
VA205013OtherCOMPSYCH
VI2182277OtherCIGNA
VA245512OtherANTHEM
VA4945263Medicaid
VA245512OtherHEALTHKEEPERS
VA7393538OtherAETNA