Provider Demographics
NPI:1528195443
Name:RICHARDSON, RECCO S (MA, LLP, LPC)
Entity Type:Individual
Prefix:MR
First Name:RECCO
Middle Name:S
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MA, LLP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 HURLEY PLZ
Mailing Address - Street 2:5TH FLOOR S.O.N.
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-5902
Mailing Address - Country:US
Mailing Address - Phone:810-762-7038
Mailing Address - Fax:810-760-0440
Practice Address - Street 1:G-1125 S. LINDEN ROAD
Practice Address - Street 2:SUITE #210
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-230-3370
Practice Address - Fax:810-230-3376
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6401008455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional