Provider Demographics
NPI:1376510834
Name:RICHARDSON, KAREN JONES (LPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JONES
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANNETTE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-0635
Mailing Address - Country:US
Mailing Address - Phone:478-953-2122
Mailing Address - Fax:478-953-2060
Practice Address - Street 1:100 KATELYN CIR STE B
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6483
Practice Address - Country:US
Practice Address - Phone:478-953-2122
Practice Address - Fax:478-953-2060
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003950101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA672422402AMedicaid