Provider Demographics
NPI:1326731332
Name:RICHARDS, COLLIN THOMAS (MED, EDS)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:THOMAS
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 NW 11TH RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-5320
Mailing Address - Country:US
Mailing Address - Phone:954-732-5596
Mailing Address - Fax:
Practice Address - Street 1:300 E UNIVERSITY AVE STE 210
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-3460
Practice Address - Country:US
Practice Address - Phone:954-732-5596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health