Provider Demographics
NPI:1326411596
Name:RICHARDS, CONCHATA S (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CONCHATA
Middle Name:S
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 LAUREL RIDGE WAY APT 2206
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-8002
Mailing Address - Country:US
Mailing Address - Phone:770-715-2130
Mailing Address - Fax:
Practice Address - Street 1:3645 MARKETPLACE BLVD STE 130-33
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5747
Practice Address - Country:US
Practice Address - Phone:470-485-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional