Provider Demographics
NPI:1124128640
Name:RICHARDS, PAMELA (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:RICHARDS
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 1:447 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-2175
Mailing Address - Country:US
Mailing Address - Phone:540-244-9496
Mailing Address - Fax:
Practice Address - Street 1:11576 LEE HWY # G
Practice Address - Street 2:
Practice Address - City:SPERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22740-2163
Practice Address - Country:US
Practice Address - Phone:540-987-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040049721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA088026MOtherSENARA - BRH
VA183971OtherANTHEM - BRH