Basic Information
| Provider Information | |||||||||
| NPI: | 1588877476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHMOND | ||||||||
| FirstName: | LAUREY | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 219 W PATRICK ST STE A | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217016933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016623223 | ||||||||
| FaxNumber: | 3016627921 | ||||||||
| Practice Location | |||||||||
| Address1: | 219 W PATRICK ST STE A | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217016933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016623223 | ||||||||
| FaxNumber: | 3016627921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 09/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LC1770 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.