Healthcare Provider Details

I. General information

NPI: 1003752676
Provider Name (Legal Business Name): TAMARA RICHARDSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70380 HIGHWAY 21 STE 2-265
COVINGTON LA
70433-8128
US

IV. Provider business mailing address

70380 HIGHWAY 21 STE 2-265
COVINGTON LA
70433-8128
US

V. Phone/Fax

Practice location:
  • Phone: 901-289-5244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15636
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: