Provider Demographics
NPI:1649745316
Name:RICHARDSON, MELAINAH K (LCDC)
Entity Type:Individual
Prefix:
First Name:MELAINAH
Middle Name:K
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 N LAURENT ST STE D
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2158
Mailing Address - Country:US
Mailing Address - Phone:361-489-0212
Mailing Address - Fax:
Practice Address - Street 1:4702 N LAURENT ST STE D
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2158
Practice Address - Country:US
Practice Address - Phone:361-489-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14325101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)