Provider Demographics
NPI:1467737742
Name:RICHARDSON-SPENCER, MARIA D (MA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:RICHARDSON-SPENCER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4590 JOHN BOY LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-7989
Mailing Address - Country:US
Mailing Address - Phone:850-321-2328
Mailing Address - Fax:
Practice Address - Street 1:4590 JOHN BOY LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-7989
Practice Address - Country:US
Practice Address - Phone:850-321-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH8540101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health