Provider Demographics
NPI:1437639671
Name:RICHARDSON, MELODY
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E WHEELING AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2510
Mailing Address - Country:US
Mailing Address - Phone:740-432-1800
Mailing Address - Fax:740-432-9299
Practice Address - Street 1:1200 E WHEELING AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2510
Practice Address - Country:US
Practice Address - Phone:740-432-1800
Practice Address - Fax:740-432-9299
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)