Provider Demographics
NPI:1063012854
Name:RICHCREEK, LETICIA OLIVIA
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:OLIVIA
Last Name:RICHCREEK
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 1:3648 EL PORTAL DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-3133
Mailing Address - Country:US
Mailing Address - Phone:530-722-1114
Mailing Address - Fax:
Practice Address - Street 1:3648 EL PORTAL DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-3133
Practice Address - Country:US
Practice Address - Phone:530-722-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)