Provider Demographics
NPI:1760603195
Name:RICHMOND, ALISHA S (PHD CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:S
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:PHD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10624 LIGHTHOUSE LANE
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134
Mailing Address - Country:US
Mailing Address - Phone:704-327-9006
Mailing Address - Fax:704-765-6434
Practice Address - Street 1:10624 LIGHTHOUSE LANE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134
Practice Address - Country:US
Practice Address - Phone:704-327-9006
Practice Address - Fax:704-765-6434
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7495235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist