Provider Demographics
NPI:1235772427
Name:RICHARDSON, CHERYL DIANE (RMHCI)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:DIANE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:D
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:389 ACORN LN
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7120
Mailing Address - Country:US
Mailing Address - Phone:352-801-9971
Mailing Address - Fax:
Practice Address - Street 1:389 ACORN LN
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7120
Practice Address - Country:US
Practice Address - Phone:352-801-9971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR263104698610Medicaid