Provider Demographics
NPI:1033875695
Name:RICHARDSON, MONICA EVETTE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:EVETTE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 VERULAM AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-2418
Mailing Address - Country:US
Mailing Address - Phone:513-841-3012
Mailing Address - Fax:513-538-3939
Practice Address - Street 1:5500 VERULAM AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-2418
Practice Address - Country:US
Practice Address - Phone:513-841-3012
Practice Address - Fax:513-538-3939
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.178832101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)