Provider Demographics
NPI:1275395014
Name:RICHARDS, YOLANDE TRICIA
Entity Type:Individual
Prefix:
First Name:YOLANDE
Middle Name:TRICIA
Last Name:RICHARDS
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 1:105 CHANTICLEER VILLAGE DR APT 105D
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6477
Mailing Address - Country:US
Mailing Address - Phone:843-213-9426
Mailing Address - Fax:
Practice Address - Street 1:250 ULTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213
Practice Address - Country:US
Practice Address - Phone:718-925-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator