Individual provider Active NPI

Stephen Richardson

  • Clinical Social Worker
  • Evans, GA
National Provider Identifier
1174062046
Registry record updated Jun 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C012054 Issued in NC
Practice address
968 Woody Hill Cir
Evans, GA 30809-6714
Phone
(704) 728-4319
NPI assigned
Feb 13, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X C012054 NC Primary
Clinical Social Worker 1041C0700X 13202 SC

Addresses

Primary practice location

968 Woody Hill Cir
Evans, GA 30809-6714

Mailing address

968 Woody Hill Cir
Evans, GA 30809-6714
Phone (704) 728-4319

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P011190NCMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781481600000",
    "number": "1174062046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "968 WOODY HILL CIR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308096714",
            "telephone_number": "704-728-4319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "968 WOODY HILL CIR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308096714",
            "telephone_number": "704-728-4319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "STEPHEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-13",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C012054",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "13202",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evans, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.