Provider Demographics
NPI:1003955345
Name:RICHMOND CO. DSS
Entity type:Organization
Organization Name:RICHMOND CO. DSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:AVANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-997-8475
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28380-0518
Mailing Address - Country:US
Mailing Address - Phone:910-997-8475
Mailing Address - Fax:910-997-8447
Practice Address - Street 1:125 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-3567
Practice Address - Country:US
Practice Address - Phone:910-997-8475
Practice Address - Fax:910-997-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700098Medicaid