Provider Demographics
NPI:1881068823
Name:RICHMOND, ANDREA DARA (CSW)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:DARA
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 E 1300 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-1947
Mailing Address - Country:US
Mailing Address - Phone:801-808-6932
Mailing Address - Fax:
Practice Address - Street 1:1164 E 1300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-1947
Practice Address - Country:US
Practice Address - Phone:801-808-6932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9435841-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical