MEDICARE: MR. RICHARD KISER L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C000904	NC

General Provider Information

NPI Number	:	1730226143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD KISER L.C.S.W.

Provider Business Mailing Address
First Line	:	303 FORESTVIEW DR
Second Line	:
City	:	ELON
State	:	NC
Zip	:	27244-9389
Country	:	US
Telephone Number	:	336-584-5003
Fax Number	:	336-586-0708

Provider Business Practice Location Address
First Line	:	3013 S CHURCH ST
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-5154
Country	:	US
Telephone Number	:	336-584-5003
Fax Number	:	336-586-0708

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. RICHARD KISER L.C.S.W.” Practice Location

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