Healthcare Provider Details

I. General information

NPI: 1760977458
Provider Name (Legal Business Name): DEBRA RICHARDS LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 EDWARDS MILL RD
RALEIGH NC
27612-4275
US

IV. Provider business mailing address

2401 PLEASANT UNION CHURCH RD
RALEIGH NC
27614-7111
US

V. Phone/Fax

Practice location:
  • Phone: 919-438-6956
  • Fax:
Mailing address:
  • Phone: 919-696-5764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP011922
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: