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General NPI Number Information
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NPI Number | 1013454636
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Entity Type | Individual
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Provider Name | MICHAEL CHARLES RICHARDS LGSW
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Gender | Male
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 118 ADAMS ST SUITE 203
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City | FAIRMONT
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State | WV
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Zip | 26554-2841
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Country | US
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Telephone | 681-404-6094
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Fax |
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Provider Business Mailing Address
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Address Line | 379 DEAN DR
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City | FAIRMONT
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State | WV
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Zip | 26554-8858
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Country | US
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Telephone | 304-366-7288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | BP00944922
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License Number State | WV
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