Provider Demographics
NPI:1013027556
Name:RICHARDSON, CONNIE Y (LPC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:Y
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-1521
Mailing Address - Country:US
Mailing Address - Phone:540-434-9700
Mailing Address - Fax:540-434-0291
Practice Address - Street 1:1164 S HIGH ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-1521
Practice Address - Country:US
Practice Address - Phone:540-434-9700
Practice Address - Fax:540-434-0291
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003459101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional