Provider Demographics
NPI:1336283548
Name:RICHARDSON, DONALD RAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RAY
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 MAPLE RUN LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-8748
Mailing Address - Country:US
Mailing Address - Phone:865-539-8256
Mailing Address - Fax:
Practice Address - Street 1:11704 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3827
Practice Address - Country:US
Practice Address - Phone:865-966-9791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1709103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling