MEDICARE: AMY LAWSON RICHARDSON LCSW

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	1041C0700X	Clinical Social Worker	C012066	NC

General Provider Information

NPI Number	:	1760163695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LAWSON RICHARDSON LCSW

Provider Business Mailing Address
First Line	:	400 FLEMINGTON DRIVE
Second Line	:
City	:	LAKE WACCAMAW
State	:	NC
Zip	:	28450
Country	:	US
Telephone Number	:	910-646-3083
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 E OLD HIGHWAY 74 76
Second Line	:
City	:	LAKE WACCAMAW
State	:	NC
Zip	:	28450-2512
Country	:	US
Telephone Number	:	910-646-3083
Fax Number	:

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

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	07/25/2023

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