Provider Demographics
NPI:1578905485
Name:RICHARDSON, ROZETIA (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:ROZETIA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BLUE MOON XING STE 3B173
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9797
Mailing Address - Country:US
Mailing Address - Phone:912-483-3344
Mailing Address - Fax:
Practice Address - Street 1:101 BLUE MOON XING STE 3B173
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-9797
Practice Address - Country:US
Practice Address - Phone:912-483-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2345106H00000X
FLMT2777106H00000X
GAMFT001756106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist