Provider Demographics
NPI:1326305806
Name:RICHARDSON, KIM ADRIENNE (LMSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ADRIENNE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:SAUGATUCK
Mailing Address - State:MI
Mailing Address - Zip Code:49453-0444
Mailing Address - Country:US
Mailing Address - Phone:312-882-5067
Mailing Address - Fax:
Practice Address - Street 1:186 S RIVER AVE STE 7
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-2848
Practice Address - Country:US
Practice Address - Phone:312-882-5067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004396101YP2500X
MI6401010578101YP2500X
MI6801098545104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker