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General NPI Number Information
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NPI Number | 1073178604
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Entity Type | Individual
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Provider Name | TEONNA MICHELLE RICHARDSON LISW
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Gender | Female
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Dates
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Enumeration Date | 05/09/2019
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 4970 BELMONT AVE
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City | YOUNGSTOWN
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State | OH
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Zip | 44505-1018
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Country | US
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Telephone | 330-759-8237
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Fax |
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Provider Business Mailing Address
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Address Line | 150 E MARKET ST
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City | WARREN
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State | OH
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Zip | 44481-1141
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Country | US
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Telephone | 330-399-6451
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1000966
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.2406027
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | S1000966
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License Number State | OH
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