Healthcare Provider Details

I. General information

NPI: 1801183850
Provider Name (Legal Business Name): LAQUANA ALICIA RICHMOND LCMHC, LCAS, CCS,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6946 SKYHAWK DR
FAYETTEVILLE NC
28314-5381
US

IV. Provider business mailing address

6946 SKYHAWK DR
FAYETTEVILLE NC
28314-5381
US

V. Phone/Fax

Practice location:
  • Phone: 336-212-9236
  • Fax:
Mailing address:
  • Phone: 336-212-9236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8965
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2671
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8965
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: