Provider Demographics
NPI:1699815092
Name:RICHARDSON, GLORIA C (LMHC)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:C
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SE 6TH AVE
Mailing Address - Street 2:206
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5185
Mailing Address - Country:US
Mailing Address - Phone:156-127-9208
Mailing Address - Fax:156-127-9289
Practice Address - Street 1:801 SE 6TH AVE
Practice Address - Street 2:206
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5185
Practice Address - Country:US
Practice Address - Phone:156-127-9208
Practice Address - Fax:156-127-9289
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0000430101Y00000X
FLMH0000430101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health