Provider Demographics
NPI:1609346402
Name:RICHARDSON, DOUGLASS (MS, CADC I)
Entity Type:Individual
Prefix:MR
First Name:DOUGLASS
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MS, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12935 ALCOSTA BLVD UNIT 3882
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-6181
Mailing Address - Country:US
Mailing Address - Phone:559-801-9834
Mailing Address - Fax:
Practice Address - Street 1:10850 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-5266
Practice Address - Country:US
Practice Address - Phone:510-875-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)