Provider Demographics
NPI:1629213681
Name:RICHMOND, ALICE DAMARIS (MAC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:DAMARIS
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:MAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 OLD HALLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-7112
Mailing Address - Country:US
Mailing Address - Phone:314-791-6771
Mailing Address - Fax:
Practice Address - Street 1:12100 OLD HALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-7112
Practice Address - Country:US
Practice Address - Phone:314-791-6771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004032820101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional