Provider Demographics
NPI:1235676719
Name:RICHARDS, CONSTANCE LEE (MSW, ACSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:LEE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MSW, ACSW, LCSW
Other - Prefix:MS
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, ACSW, LCSW
Mailing Address - Street 1:4323 LACLEDE AVE APT B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2251
Mailing Address - Country:US
Mailing Address - Phone:314-732-3217
Mailing Address - Fax:
Practice Address - Street 1:655 CRAIG RD
Practice Address - Street 2:SUITE 160
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7132
Practice Address - Country:US
Practice Address - Phone:314-732-3217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0020431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical