Provider Demographics
NPI:1699398453
Name:RICHARDSON, ANASTASIA ROSE (MS, LCGC, CCGC)
Entity Type:Individual
Prefix:MS
First Name:ANASTASIA
Middle Name:ROSE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MS, LCGC, CCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 - 2330 MAPLE STREET
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:BC
Mailing Address - Zip Code:V6J 3T6
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4500 OAK STREET
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:BC
Practice Address - Zip Code:V6H 3N1
Practice Address - Country:CA
Practice Address - Phone:604-875-2000
Practice Address - Fax:604-875-2376
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAGT60789113170300000X
UT10467973-3601170300000X
CAGC000572170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10467973-3601OtherLICENSURE
CAGC000572OtherLICENSURE NUMBERS
WAGT60789113OtherLICENSURE