Provider Demographics
NPI:1588840615
Name:WILLIAMS, RICHELLE MARIE (LCPC, LMFT, CADC)
Entity Type:Individual
Prefix:MRS
First Name:RICHELLE
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCPC, LMFT, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3648 GUNDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3878
Mailing Address - Country:US
Mailing Address - Phone:708-488-8000
Mailing Address - Fax:
Practice Address - Street 1:7627 LAKE ST STE 213
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1878
Practice Address - Country:US
Practice Address - Phone:708-488-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003418101YP2500X
IL166-000517106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633354OtherBLUE CROSS BLUE SHIELD