Provider Demographics
NPI:1225117120
Name:RICHARDS, ALFRED LUTHER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:LUTHER
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:FRED
Other - Middle Name:LUTHER
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:301 DIXIE ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3310
Mailing Address - Country:US
Mailing Address - Phone:770-834-8143
Mailing Address - Fax:
Practice Address - Street 1:309 TANNER ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3207
Practice Address - Country:US
Practice Address - Phone:770-834-4415
Practice Address - Fax:770-834-1865
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANBCC 5367101Y00000X
GALPC000514101YP2500X
GAMFT000230106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GANBCC 5367OtherNATIONAL CERTIFIED COUNS.
GAMFT000230OtherLIC.MARR.& FAM. THER.
GALPC000514OtherLICENSED PROFESS. CNSLR