Provider Demographics
NPI:1568473445
Name:RICHARDSON, GREGORY JOHN (MA LPC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JOHN
Last Name:RICHARDSON
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Gender:M
Credentials:MA LPC
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Mailing Address - Street 1:36250 DEQUINDRE RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-7143
Mailing Address - Country:US
Mailing Address - Phone:586-795-0569
Mailing Address - Fax:586-795-2761
Practice Address - Street 1:36250 DEQUINDRE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-7143
Practice Address - Country:US
Practice Address - Phone:586-795-0569
Practice Address - Fax:586-795-2761
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6401005860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional