Provider Demographics
NPI:1326604984
Name:RICHARDS, JOANNE CAROL (CAC)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:CAROL
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WHITEHALL AVE
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1966
Mailing Address - Country:US
Mailing Address - Phone:860-961-5702
Mailing Address - Fax:860-415-9370
Practice Address - Street 1:49 WHITEHALL AVE
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1966
Practice Address - Country:US
Practice Address - Phone:860-961-5702
Practice Address - Fax:860-415-9370
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-19
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCAC-6407101YA0400X
CT6407101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty