Provider Demographics
NPI:1770732976
Name:RICHMOND, LAWRENCE JIMMIE II (MA)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JIMMIE
Last Name:RICHMOND
Suffix:II
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 JOHNSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4818
Mailing Address - Country:US
Mailing Address - Phone:304-952-1193
Mailing Address - Fax:
Practice Address - Street 1:502 JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4818
Practice Address - Country:US
Practice Address - Phone:304-952-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV968103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical