Provider Demographics
NPI:1740914365
Name:RICHARDSON, MALACHI AMON (PHD)
Entity type:Individual
Prefix:DR
First Name:MALACHI
Middle Name:AMON
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 4TH ST SE APT 831
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3637
Mailing Address - Country:US
Mailing Address - Phone:305-801-8970
Mailing Address - Fax:
Practice Address - Street 1:400 7TH ST NW STE 500
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20004-2324
Practice Address - Country:US
Practice Address - Phone:305-801-8970
Practice Address - Fax:877-809-0772
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07067103TC0700X
VA0810007862103TC0700X
DCPSY200001366103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical