Provider Demographics
NPI:1386278463
Name:RICHARDS, SAMANTHA R (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:R
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:R
Other - Last Name:DECASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1005 KENNESAW SPRINGS DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5603
Mailing Address - Country:US
Mailing Address - Phone:267-760-2815
Mailing Address - Fax:
Practice Address - Street 1:1005 KENNESAW SPRINGS DR NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5603
Practice Address - Country:US
Practice Address - Phone:267-760-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0069851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1386278463Medicaid