Provider Demographics
NPI:1043545395
Name:RICHARDSON, MARGARET (AAS,CCJP,CACD,ICRC)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:AAS,CCJP,CACD,ICRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8145 FENKELL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-1867
Mailing Address - Country:US
Mailing Address - Phone:313-742-1623
Mailing Address - Fax:313-836-1315
Practice Address - Street 1:8145 FENKELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-1867
Practice Address - Country:US
Practice Address - Phone:313-742-1622
Practice Address - Fax:313-836-1315
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI820805101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor