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General NPI Number Information
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NPI Number | 1508481375
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Entity Type | Individual
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Provider Name | ANDREA CHENISE RICHARDSON LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 5900 YORK RD STE 203
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City | BALTIMORE
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State | MD
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Zip | 21212-3040
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Country | US
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Telephone | 410-323-3236
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Fax | 410-323-3239
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Provider Business Mailing Address
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Address Line | 43602 S TIMBERVIEW DR
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City | VAN BUREN TWP
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State | MI
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Zip | 48111-3354
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Country | US
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Telephone | 734-223-6827
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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 | 25602
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License Number State | MD
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