Healthcare Provider Details

I. General information

NPI: 1437317278
Provider Name (Legal Business Name): UGANDA TUNISIA RICHARDSON BSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/03/2025
Certification Date: 05/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3012 MONTGOMERY ST
HOBBS NM
88240-1424
US

IV. Provider business mailing address

1782 N. TURNER ST 1020
HOBBS NM
88240
US

V. Phone/Fax

Practice location:
  • Phone: 405-204-7813
  • Fax:
Mailing address:
  • Phone: 405-204-7813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12577
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4997
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2022-0713
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: