Provider Demographics
NPI:1770924995
Name:RICHARDSON, LAQUANDA RENEE (BS)
Entity type:Individual
Prefix:
First Name:LAQUANDA
Middle Name:RENEE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 S CHICKASAW TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8627
Mailing Address - Country:US
Mailing Address - Phone:407-494-1673
Mailing Address - Fax:
Practice Address - Street 1:3405 S CHICKASAW TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-8627
Practice Address - Country:US
Practice Address - Phone:407-494-1673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator