Provider Demographics
NPI:1053777987
Name:RICHARDSON, LADONNA DENISE (LCSW)
Entity type:Individual
Prefix:
First Name:LADONNA
Middle Name:DENISE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0640
Mailing Address - Country:US
Mailing Address - Phone:252-536-5440
Mailing Address - Fax:252-536-5444
Practice Address - Street 1:204 EVANS RD
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:NC
Practice Address - Zip Code:27844-9247
Practice Address - Country:US
Practice Address - Phone:252-586-5151
Practice Address - Fax:252-586-6932
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0115721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical