Provider Demographics
NPI:1285171785
Name:RICHARDSON, ANGELA RILEY (MS, LPCA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RILEY
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MS, LPCA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:FAYE
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, NCC
Mailing Address - Street 1:416 RIVERWALK DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-2540
Mailing Address - Country:US
Mailing Address - Phone:334-740-8960
Mailing Address - Fax:
Practice Address - Street 1:621 HUNTSMAN CT
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-6060
Practice Address - Country:US
Practice Address - Phone:704-671-4487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12643101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional