Provider Demographics
NPI:1689044901
Name:RICHARDS, JESSICA (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BEACON CV
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5892
Mailing Address - Country:US
Mailing Address - Phone:770-595-9478
Mailing Address - Fax:
Practice Address - Street 1:200 BEACON CV
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5892
Practice Address - Country:US
Practice Address - Phone:770-595-9478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001696106H00000X
GAAPC005008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional