Provider Demographics
NPI:1083958524
Name:RICHARDSON, MURIEL (MS LCPC)
Entity Type:Individual
Prefix:
First Name:MURIEL
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-1022
Mailing Address - Country:US
Mailing Address - Phone:443-625-9029
Mailing Address - Fax:
Practice Address - Street 1:5202 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE 104
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-1022
Practice Address - Country:US
Practice Address - Phone:443-625-9029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional