Provider Demographics
NPI:1598548638
Name:RICHARDSON, NIKKI J
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:J
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78775 LAMBORN RD
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907-9447
Mailing Address - Country:US
Mailing Address - Phone:740-310-6991
Mailing Address - Fax:
Practice Address - Street 1:78775 LAMBORN RD
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-9447
Practice Address - Country:US
Practice Address - Phone:740-310-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health