=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356360010
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LENA C RICHARDSON M.S.W
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 FREEDOM WAY
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30904-6258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-481-6746
-----------------------------------------------------
Fax | 706-731-7261
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1132 VILLAGE CT
-----------------------------------------------------
City | EVANS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30809-5245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-481-6746
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC01272300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------