Provider Demographics
NPI:1144312901
Name:RICHARDS, AMY MARGARET (LISW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARGARET
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 MEADOWSWEET LANE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-7502
Mailing Address - Country:US
Mailing Address - Phone:864-497-2882
Mailing Address - Fax:864-587-4379
Practice Address - Street 1:175 MAGNOLIA STREET
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-6151
Practice Address - Country:US
Practice Address - Phone:864-497-2882
Practice Address - Fax:864-587-4379
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLN-71861041C0700X
SC71861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid
SC301100Medicaid