Provider Demographics
NPI:1699282103
Name:RICHARDSON, TAMECA RASHAUN (QMHP, CSAC-A, PMP)
Entity type:Individual
Prefix:
First Name:TAMECA
Middle Name:RASHAUN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:QMHP, CSAC-A, PMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 SIMMONS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-8942
Mailing Address - Country:US
Mailing Address - Phone:336-254-5163
Mailing Address - Fax:434-608-0504
Practice Address - Street 1:606 BROAD ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-3200
Practice Address - Country:US
Practice Address - Phone:434-265-5004
Practice Address - Fax:434-608-0504
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0711000387101YA0400X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)