Provider Demographics
NPI:1508296500
Name:RICHARDSON, MICHAEL (LCMHC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 HARREL ST
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8526
Mailing Address - Country:US
Mailing Address - Phone:802-888-5026
Mailing Address - Fax:
Practice Address - Street 1:72 HARREL ST
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8526
Practice Address - Country:US
Practice Address - Phone:802-888-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0074419101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health